Pancreatitis and Primary Hyperparathyroidism: Forty Cases

Abstract

Background: Pancreatitis is associated with primary hyperparathyroidism (PHPT) in 1.5-7% of cases. The relationship of cause and effect between the two diseases has been debated. Methods: To evaluate this relationship, the clinical, biochemical and pathological data on 1435 patients operated on for hyperparathyroidism (HPT) over the past 30 years were retrospectively reviewed. A total of 1224 of these patients had biologically proven and cured PHPT and 21 1 patients had renal HPT (RHPT). The diagnosis of pancreatitis (PTS) was based on a high serum amylase level andor abnormalities on ultrasound or computed tomography (CT) scan explorations. Only patients without biliary stones were included in the PTS group associated with HPT. Results: A total of 3.2% (n = 40) of patients with PHPT had PTS, which was acute in 18 cases, subacute in 8 cases and chronic in 14 cases. This rate of PTS is higher than in a random hospital population. Surgical cure of HPT was followed by the spontaneous healing of 17/18 acute PTS, whereas six of the 22 patients with subacute or chronic PTS developed complications due to the evolution of their disease (diabetes, pancreatic duct stenosis treated by surgery). A single diseased gland was found in 27 patients with PTS, which is in favour of primary parathyroid disease, being responsible for, and not a consequence of, PTS. Only the serum calcium (13.0 vs 12.1 g/dL) level was significantly increased in PHPT patients with PTS, when compared to those without PTS. The calcium level is probably of major importance in the development of PTS, which was never encountered in 21 I patients with RHPT, who had low calcium and high PTH levels. Conclusions: The data suggest that (i) the PTS-PHPT association is not incidental; (ii) PTS is the consequence and not the cause of PHPT; (iii) hypercalcaemia seems to be a major factor in the development of PTS in PHPT patients; and (iv) cure of PHPT leads to the healing of acute PTS, whereas it does not affect the evolution of subacute and chronic PTS.

Parathyroid Carcinoma Presenting as an Acute Pancreatitis

“…Since Cope and colleagues in 1957 described pancreatitis as another manifestation of hyperparathyroidism [4], several publications report that as many as 7%-19% of patients with PHPT have associated pancreatitis [3,[8][9][10]. The mechanism of PHPT-induced pancreatitis is still controversial.…”

The Rise of Calcium and Control of its Fall

“…Gastrointestinal manifestations include anorexia, nausea, vomiting, vague abdominal pain, constipation, peptic ulcer disease, and acute pancreatitis. The incidence of acute pancreatitis in patients with primary hyperparathyroidism is reported to be 1.5% [6]. In 2012 in the Journal of Clinical Gastroenterology [7], a literature review was performed on the association of primary hyperparathyroidism with pancreatitis, which identified 10 retrospective studies each with >50 patients diagnosed with primary hyperparathyroidism (PHPT), and with the exception of two studies, the rate of pancreatitis among patients with PHPT was higher than that reported overall among hospitalized patients without PHPT.…”

S3-Leitlinie Chronische Pankreatitis: Definition, Ätiologie, Diagnostik, konservative, interventionell endoskopische und operative Therapie der chronischen Pankreatitis. Leitlinie der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS)

“…[23]. Etwa 1 % der Patienten mit einer Pankreatitis hat zusätzlich einen pHPT und 12 % der Patienten mit pHPT haben zusätzlich eine Pankreatitis [24]. Somit haben Patienten mit einem pHPT ein 28-fach erhöhtes Risiko, eine Pankreatitis zu entwickeln.…”

“…Somit haben Patienten mit einem pHPT ein 28-fach erhöhtes Risiko, eine Pankreatitis zu entwickeln. Kontrollierte Studien existieren nicht [23,24]. [36].…”