Parathyroid adenoma presenting as chronic pancreatitis: A case report and literature review

Abstract

Background: Most patients with parathyroid adenomas are asymptomatic and rarely present with chronic pancreatitis (CP). Several studies have reported a positive association between primary hyperparathyroidism (PHPT) and pancreatitis. Parathyroidectomy is the definitive treatment for PHPT. IV bisphosphonates can be considered the drug of choice for bridge to surgery.Methods: We reported a 57-year-old female patient was admitted to the emergency room with left upper quadrant abdominal pain and a diagnosis of recurrent pancreatitis. Magnetic Resonance Cholangiopancreatography confirmed the diagnosis of CP. The patient had no common etiology of pancreatitis. Persistent hypercalcemia was noted despite administering intravenous fluids, and Calcitonin. Intravenous Pamidronate, a Bisphosphonate derivative, was also administered. Although calcium levels initially decreased, they were later found to rebound to previous levels.Results: A diagnosis of parathyroid adenoma and PHPT was made based on the elevated parathyroid hormone levels and cervical ultrasonography indicated right inferior parathyroid adenoma. Technetium-99m methoxy-isobutyl-isonitrile scintigraphy revealed a focal hot spot of tracer accumulation at the right lower thyroid bed. The patient underwent right lower parathyroidectomy smoothly and successfully. After right lower parathyroidectomy, she had normal serum calcium levels (9.2 mg/dL) and parathyroid hormone (16.1 pg/mL). There was no recurrent abdominal pain after the operation.Conclusion: CP is a rare manifestation of parathyroid adenoma. When patients with a history of recurrent pancreatitis, without common causes of pancreatitis, present persistent elevated serum calcium levels, PHPT could be suspected.

Turning Points in Cross-Disciplinary Perspective of Primary Hyperparathyroidism and Pancreas Involvements: Hypercalcemia-Induced Pancreatitis, MEN1 Gene-Related Tumors, and Insulin Resistance

“…Summarizing, in addition to the five previously mentioned cases of pregnancy primary hyperparathyroidism [37][38][39]41,42] and three reports of a parathyroid carcinoma [47][48][49], another seventeen articles introduced one patient per case study, except for two papers with two subjects (a total of nineteen individuals). Four children (aged between 9 and 14 years; an average age of 12; female-to-male ratio of three to one) and fifteen adults (aged between 31 and 81 years; mean age of 51.6 years; female-to-male ratio of two to one) were reported within the last five years in the field of hypercalcemia-derivate pancreatitis in patients with parathyroid NETs (N = 27 individuals) [18,21,22,25,34,35,[53][54][55][56][57][58][59][60][61][62][63] (Table 4). From a cross-disciplinary perspective, the synchronous identification of pancreatitis and primary hyperparathyroidism requires the dual management of pancreatic involvement and hypercalcemia in the sense of rapid calcium lowering, and, when clinically stable, a definite cure of primary hyperparathyroidism should be provided by parathyroidectomy.…”

“…Usually, an acute episode of pancreatitis is not recognized as being triggered by primary hyperparathyroidism, and patients continue to have two or three episodes until adequate identification of the underlying parathyroid condition [ 22 , 54 ]. For instance, Mehta et al [ 55 ] reported the case of an adult lady who suffered from three episodes of acute pancreatitis during six months in the absence of alcohol consumption or gallstones until parathyroid-related hypercalcemia was incriminated as the pancreatic disease [ 55 ].…”

“…Summarizing, in addition to the five previously mentioned cases of pregnancy primary hyperparathyroidism [ 37 , 38 , 39 , 41 , 42 ] and three reports of a parathyroid carcinoma [ 47 , 48 , 49 ], another seventeen articles introduced one patient per case study, except for two papers with two subjects (a total of nineteen individuals). Four children (aged between 9 and 14 years; an average age of 12; female-to-male ratio of three to one) and fifteen adults (aged between 31 and 81 years; mean age of 51.6 years; female-to-male ratio of two to one) were reported within the last five years in the field of hypercalcemia-derivate pancreatitis in patients with parathyroid NETs (N = 27 individuals) [ 18 , 21 , 22 , 25 , 34 , 35 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ] ( Table 4 ).…”

“…Reported data (case studies) on pancreatitis in patients with PTH-related hypercalcemia during the diagnosis of primary hyperparathyroidism according to our research (the table starts with the most recent publication date)[18,21,22,25,34,35,[53][54][55][56][57][58][59][60][61][62][63].…”

Minimal invaziv paratiroidektomi. Tek merkez deneyimi.

“…3 Paratiroid bezlerinin en sık saptanan benign tümörlerinden birisi olan paratiroid adenomları PHPT %80'inden daha fazlasından sorumludur. 4 PHPT tedavisi, görüntüleme yöntemlerindeki gelişmeler ve prospektif çalışmaların sonuçlarının ortaya konması ile son 20-30 yılda kapsamlı bir değişim geçirmiştir. Güncel kılavuzlar serum PTH düzeyleri yüksek olan ve hiperkalsemiye bağlı komplikasyonların ortaya çıktığı hastalarda paratiroidektomi yapılmasını önermektedir.…”