Acute pancreatitis associated with hypercalcemia: A report of two cases

Abstract

Hypercalcemia due to hyperparathyroidism is a rare etiology for acute pancreatitis, oscillating between 1.5 and 7% in the different series. Although the cause-effect relationship and the pathophysiology of the condition are not clear, it seems that the association among them is not incidental, and serum calcium could be a major risk factor, so that pancreatitis would come to occur during severe hypercalcemia attacks. Mutations in different genes have been proposed as well to justify why only some patients with primary hyperparathyroidism and hypercalcemia develop acute pancreatitis.References to cases like these ones are rare in the literature. We report two patients with acute pancreatitis associated with hyperparathyroidism and hypercalcemia, one of them with a fatal outcome.

Ectopic mediastinal parathyroid adenoma: a cause of acute pancreatitis

“…Less often, PHP leads to acute pancreatitis. The occurrence of acute pancreatitis secondary to hypercalcemia is rare [5][6][7]. Here, we report a case of acute pancreatitis that occurred secondary to hypercalcemia due to an ectopic parathyroid adenoma in the mediastinum.…”

Acute pancreatitis as a precursor sign of parathyroid adenoma

“…[9] The persistent hypercalcemia may lead to increased calcium concentrations in pancreatic juice and calcium activation of trypsinogen within pancreatic parenchyma and disruptions acinar cell. [9][10][11] Long-standing hypercalcemia may also decrease the volume of pancreatic juice and cause protein plugs leading to an obstruction in the pancreatic duct. [12] Some authors have described that PTH may act itself and cause local thrombo-endarteritis and necrosis of pancreatic tissue.…”

Pancreatitis aguda asociada con hipercalcemia

“…El hiperparatiroidismo primario es la causa más común de hipercalcemia, puede ocurrir en cualquier edad, sin embargo, en la mayoría de los casos se reporta por encima de los 45 años, con una predominancia en el sexo femenino de 2: 1 1 .…”

“…De acuerdo a Egea 1 la asociación entre hiperparatiroidismo primario y pancreatitis aguda fue descrita por Erdheim en 1903, mientras que la asociación con pancreatitis crónica fue publicada por Martin y Canseco en 1947; sin embargo, no fue hasta Cope et al en 1957, que se consideró como otra manifestación del hiperparatiroidismo primario 1,2 .…”