Primary Hyperparathyroidism and Pancreatitis: A Rare Association with Multiple Facets

Abstract

Primary hyperparathyroidism (PHPT) is rarely associated with the occurrence of acute or chronic pancreatitis. Hypercalcemia plays a major role in the pathogenesis. We report five cases of pancreatitis revealing PHPT. Patients and Methods. This is a retrospective study of 4 years, including all patients admitted to intensive care unit or gastroenterology department, for an acute or chronic pancreatitis revealing primary hyperparathyroidism. Results. We included 5 patients, all female, with mean age 54 years [40–76 years]. The PHPT was in all cases revealed by acute pancreatitis (AP). This one was oedematous in four cases and severe in one case. It occurred twice in calcified chronic pancreatitis (CCP). There was hypercalcemia in all cases. The PHPT was associated with a high rate of parathyroid hormone in 4 cases. The secreting lesion was an adenoma in 5 cases. Two patients had in addition bilateral renal calcifications. The outcome was favorable in 4 patients among whom 3 have had parathyroid surgery. A death was noted by superinfection of necrosis in the case of severe AP. Conclusion. The occurrence of pancreatitis during hyperparathyroidism is rare. Normal or elevated calcemia during acute or chronic pancreatitis should always get attention.

Mandibular Brown Tumor as Atypical Presentation of Primary Hyperparathyroidism: two Case Reports And Literature Review

“…our institution, HPT patients with pancreatitis had bigger adenomas, higher serum ionized PTH, more severe hypercalcemia, and suffered more often from nephrolithiasis compared with HPT patients without pancreatitis (14). It is interesting to point out that HPT-related pancreatitis is most often reported in tropical countries, where serum vitamin D levels are higher.…”

“…Among the potential effects of hypercalcemia is acute pancreatitis. This complication is reported in 1.5 to 13% of patients with HPT, representing up to a 30-fold increase in risk compared to the general population (14). At the same time, however, less than 1% of acute pancreatitis cases are thought to be caused by HPT (15), and the pathophysiology of pancreatitis as a complication of HPT is still unclear.…”

“…At the same time, however, less than 1% of acute pancreatitis cases are thought to be caused by HPT (15), and the pathophysiology of pancreatitis as a complication of HPT is still unclear. Mechanisms proposed include deposits of calcium and calcium calculi in the pancreatic ducts and the activation of trypsinogen to trypsin (14,15). Roles for gene mutations to the serine protease inhibitor Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator (CFTR), and calcium-sensing receptor (CaSR) genes have also been proposed (14).…”

“…Mechanisms proposed include deposits of calcium and calcium calculi in the pancreatic ducts and the activation of trypsinogen to trypsin (14,15). Roles for gene mutations to the serine protease inhibitor Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator (CFTR), and calcium-sensing receptor (CaSR) genes have also been proposed (14). Blood calcium values during pancreatitis are usually observed to fall.…”

“…Patients with PHPT also have elevated plasma levels of 1,25-dihydroxyvitamin D, which further increases hypercalcemia. Another possible factor is the fact that malnutrition is generally more prevalent in tropical countries and therefore serum albumin levels are generally lower which can result in greater ionized calcium levels even while total serum calcium is unchanged (14)(15)(16).…”