Acute pancreatitis caused by an ectopic mediastinal parathyroid adenoma

Abstract

A 22-year-old man was admitted to our hospital because of epigastric pain. Blood tests showed leukocytosis (8940 cells/mm(3)) and increased serum amylase levels (787 IU/L); an abdominal computed tomography (CT) scan revealed an enlarged pancreas and peripancreatic fluid collection. On the basis of these findings, he was diagnosed with acute pancreatitis. Hypercalcemia (13.5 mg/dL) and increased levels of parathormone (>3200 pg/dL) were also detected using a high-sensitivity assay; we therefore considered hypercalcemia and primary hyperparathyroidism to be the possible causes of the acute pancreatitis. A (99m)Tc-sestamibi scan showed accumulation of parathyroid tissue in the left mediastinum, and a tumor was noted on the left side of the aortic arch on a thoracic CT scan. Our final diagnosis was acute pancreatitis due to hypercalcemia induced by an ectopic mediastinal parathyroid adenoma. Ectopic parathyroid tumors can thus cause acute pancreatitis, and (99m)Tc-sestamibi and CT scans are useful for their diagnosis and localization.

Large mediastinal parathyroid adenoma presenting with acute pancreatitis

“…Ectopic mediastinal parathyroid adenoma presenting with pancreatitis is rare and after thorough review of literature, we could find only few such previous reports. [ 1 3 4 5 ] In our case, patient presented with hypercalcemia during evaluation of pancreatitis and diagnosed to have PHPT with large mediastinal parathyroid adenoma. In fact, such large size mediastinal tumor should raise suspicion of parathyroid carcinoma as well, which was not revealed in histopathology in our case.…”