A Case Report on Recurrent Acute Pancreatitis with Primary Hyperparathyroidism

Abstract

Abstract:Pancreatitis is a common non-bacterial inflammatory disease caused by activation, interstitial liberation and auto digestion of pancreas by its own enzymes. Common causes of acute pancreatitis are gall stones, alcohol, drugs, trauma, viral infections and hypertriglyceridemia. Much is known about the causes of pancreatitis but huge experimental data available about understanding of its pathogenesis is still incomplete. Hypercalcemia as a cause of pancreatitis is rarely reported. Hypercalcemia is usually the result of Primary hyperparathyroidism (PHPT) and the most common cause of PHPT is parathyroid adenoma. It is thought that the increased calcium concentration in pancreatic juice resulting from hypercalcemia may prematurely activate proteases. Mutations in different genes have been proposed as well to justify why only some patients with primary hyperparathyroidism and hypercalcemia develop acute pancreatitis. Here we present a case of recurrent acute pancreatitis resulting from hypercalcemia due to parathyroid adenoma in a 38-year-old man. Hyperparathyroidism was suspected when despite severe pancreatitis calcium level remained high and parathormone level was grossly raised

Hypercalcemic Pancreatitis: A Rare Type of Acute Pancreatitis Caused by a Parathyroid Adenoma

“…Usually Serum calcium level is low during acute pancreatitis. Thus, whenever acute pancreatitis is associated with hypercalcemia, complementary explorations should undergo, considering the possibility of hypercalcemia related pancreatitis and try to exclude PHPT [1,11,22] . As a matter of fact, in our case, PHPT could justify the whole clinical presentation: not only hypercalcemia was secondary to PHPT, but also bone lesions were benign and related to PHPT.…”

“…As far as treatment, the management of acute pancreatitis episodes is not altered by PHPT, which should focus on intensive supportive care [1,10] . Fluid resuscitation with intravenous fluids remains the basis of treatment, with pain management; however, rehydration with lactated Ringer's solution is contraindicated because it contains calcium [9] .…”

“…Fluid resuscitation with intravenous fluids remains the basis of treatment, with pain management; however, rehydration with lactated Ringer's solution is contraindicated because it contains calcium [9] . After the acute crisis has resolved, patients should undergo elective parathyroidectomy to definitively treat the PHPT [1,10] . Pending the surgery, the management of hypercalcemia is based on rehydration with isotonic saline and bisphosphonates [2,9] .…”

“…Acute pancreatitis has multiple etiologies, dominated by biliary lithiasis and alcohol consumption [1] . Among other causes, hypercalcemia associated with acute pancreatitis is rare [2] .…”

“…Primary hyperparathyroidism (PHPT) with subsequent hypercalcemia caused by parathyroid adenoma causing pancreatitis as the first manifestation is exceptionally rare with debatable and controversial association [3,4] . Although, it is though that elevated parathyroid hormone and high serum calcium levels associated with certain genetic mutations could be responsible for this predisposition in some patients with hyperparathyroidism causing calcium deposit in the pancreatic ducts which then activates the pancreatic enzymes [1,5,6] . Here, we present the case of a hypercalcemic acute pancreatitis as a first presentation of primary hyperparathyroidism caused by a parathyroid adenoma in a middle-aged woman.…”