Pancréatite aiguë et hyperparathyroïdie primaire : étude multicentrique de l’Association francophone de chirurgie endocrinienne

Primary Hyperparathyroidism and Pancreatitis: A Rare Association with Multiple Facets

“…Pancreatitis occurs at an advanced stage of parathyroid disease [ 1 ], which would explain the low prevalence of this association in the developed countries, PHPT being diagnosed earlier. The mean age at diagnosis is variable, but patients are older than those with only PHPT [ 2 , 6 ]. They are young adults in midlife in the cases described in India and Latin America [ 2 , 7 , 8 ], while patients were older (60–70 years) in the United States and France [ 5 , 6 ].…”

“…The mean age at diagnosis is variable, but patients are older than those with only PHPT [ 2 , 6 ]. They are young adults in midlife in the cases described in India and Latin America [ 2 , 7 , 8 ], while patients were older (60–70 years) in the United States and France [ 5 , 6 ]. The male sex is predominant in most studies with about 60 and 70% of men [ 2 , 7 , 8 ], in contrast to patients with only a single PHPT.…”

“…The occurrence mechanism of pancreatitis during PHPT remains controversial but may be related to hypercalcemia, only statistically significant factor associated [ 6 ]. Shah suggested that a high calcium level in more than 1.3 times normal was associated with a risk of occurrence of an AP [ 9 ].…”

“…Hypercalcemia would act by several mechanisms: increased level of calcium in pancreatic juice at the origin of activation of trypsinogen to trypsin; activation of pancreatic enzymes through the lysosomal system and hydrolases; calcium precipitation and formation of protein plugs responsible for upstream pancreatitis. The direct toxic action of PTH on the pancreas is mentioned, but pancreatitis is not usually found in dialysis patients with elevated PTH [ 6 ], and PTH is not higher in patients with pancreatitis in the course of PHPT [ 2 , 6 ]. A genetic risk factor has also been found.…”

“…The diagnosis is made by the PTH dosage which was elevated in 4 of our patients. PTH in patients with pancreatitis on PHPT is not higher than among those with only PHPT [ 2 , 5 , 6 ]. The localization of the secretory lesion was made by the anterior cervical ultrasound and CT scan.…”