Pancreatitis Following Parathyroid Surgery

Abstract

While pancreatitis may provide the clue to the diagnosis of hyperparathyroidism preoperatively, the occurrence of pancreatitis following parathyroidectomy is not generally recognized. In this study preoperative and postoperative serum amylase estimations, together with a clinical assessment, were performed on 86 patients undergoing neck exploration for hyperparathyroidism. It was found that postoperative hyperamylasaemia occurred in 35% of the total group, while clinically significant pancreatitis was found in 9% of cases. Pancreatitis was significantly more common when thyroidectomy was performed at the time of parathyroidectomy, occurring in 23% of this group of patients, and may be due to the blunted C-cell response of calcitonin secretion to the induced hypercalcaemia associated with operative manipulation. Careful attention should be paid to postoperative abdominal symptoms, for they may indicate pancreatitis.THE RELATIONSHIP between the pancreas and parathyroid glands was the subject of a number of case reports in the literature earlier this century," 2 but it was not until 1957 that Cope3 first demonstrated that pancreatitis may be the presenting symptom of hyperparathyroidism. This relationship is now generally accepted, although some more recent series4 have shown that the incidence is probably lower than that claimed in earlier reports, which gave figures of up to 10%.5 Other authors6 claim that pancreatitis is only a chance occurrence and that there is no relationship between the two disorders at all.The converse relationship, i.e., pancreatitis following parathyroid surgery in patients who had not previously had pancreatitis, has been less well documented, with only isolated reports being found.7'8 The purpose of this study was to investigate the incidence of postoperative pancreatitis in patients undergoing neck exploration for hyperparathyroidism. A single adenoma was removed in 66 cases, and two adenomas were removed in one case; a subtotal parathyroidectomy was performed in' 13 cases; a parathyroid carcinoma was removed in one case, metastatic adenocarcinoma in a lymph node was found in one case, and no parathyroid pathology wasJ identified in three patients, one of whom had two sep' arate operative procedures. Serum amylase estimations were performed on 74 patients preoperatively and on all 86 patients postop,eratively. The postoperative amylase estimations were repeated on a daily basis for 48 hours or until the levels had returned to normal. In addition, a record was kept of the occurrence of significant abdominal pain or of any other clinical finding consistent with pancreatitis' Serum amylase estimations were also performed both preoperatively and postoperatively on a control group of 34 patients undergoing thyroid surgery (either total thyroidectomy, total thyroid lobectomy, or bilateral subtotal thyroidectomy) in whom no parathyroid surgery was performed.i Nasogastric suction and intravenous fluids were used postoperatively. In the absence of a raised serum amylase level or abdominal pain,...

Does Hyperparathyroidism Cause Pancreatitis? A South Indian Experience and a Review of Published Work

“…In 1962 Mixter et al reported 62 cases of pancreatitis occurring in association with primary hyperparathyroidism (PHPT) after reviewing the published work 2 . Subsequent reports have focused on the development of pancreatitis in patients who are operated on for hyperparathyroidism 3–5 . The contradictory point was raised in 1980 when Bess et al reviewed 1153 patients and showed the coexistence or history of pancreatitis in only 1.5% of patients and suggested that the association may be casual rather than causal 6 .…”

Acute pancreatitis associated with primary hyperparathyroidism

“…In this series a 3.2% incidence (40 patients) of pancreatitis was found (acute/subacute in 26 and chronic in 14). Only serum calcium level was significantly increased in HPT patients with pancreatitis when compared with those without pancreatitis.…”

“…In a series of 86 patients undergoing neck exploration for HPT reported by Reeve et al [14], the incidence of postoperative pancreatitis was 9%. A possible mechanism proposed by Lambert et al [15] to explain the onset of pancreatitis after parathyroidectomy is based on acutely elevated serum calcium level.…”

Metabolic pancreatitis: Etiopathogenesis and management

“…[42] Subsequent reports have focused on the development of pancreatitis in patients who are operated on for hyperparathyroidism. [434445] However, while some studies have found an increased incidence of pancreatitis in patients with PHPT, others have not. [37] One possible reason for this turn could be the changing profile of PHPT in the developed countries, where symptomatic disease remains uncommon and pancreatic disease with PHPT extremely rare.…”