Recurrent acute pancreatitis as the first and sole presentation of undiagnosed primary hyperparathyroidism

Abstract

Introduction We highlight the pitfalls in delaying the diagnosis of primary hyperparathyroidism (pHPT) in patients with acute pancreatitis as the sole clinical presentation. Primary hyperparathyroidism is a recognised, but rare, cause of acute pancreatitis. Hypercalcaemia caused by undiagnosed pHPT may be the only causative factor of recurrent acute pancreatitis. Patients and methods Three patients with multiple admissions for acute pancreatitis were diagnosed having pHPT during the work-up to identify possible causative factors. None of the patients had any other common predisposing factor for acute pancreatitis as revealed by clinical examination, blood tests and imaging. In retrospect, all had abnormally elevated calcium during previous admissions which was not further assessed. Results After diagnosis of pPTH, patients underwent bilateral neck exploration and parathyroidectomy. Histology confirmed parathyroid adenomas. The blood calcium level returned to normal and the patients remain well and asymptomatic after operation. Conclusions The role of pHPT as a causative factor is underestimated when managing patients with acute pancreatitis, and frequently the underlying disease remains undiagnosed for a long time. Proper early diagnosis and management prevent unnecessary morbidity.

Acute pancreatitis connected with hypercalcemia crisis in hyperparathyroidism: A case report

“…However, acute pancreatitis as the first clinical presentation in PHPT is rare. Hypercalcemia caused by undiagnosed PHPT may be the only causative factor in acute pancreatitis[8]. Therefore, this disease is often misdiagnosed or overlooked completely during clinical consultation.…”

Pathologic Fractures: A Neglected Clinical Feature of Parathyroid Adenoma

“…In this case decreased bone density and two pathologic fractures in the neck of the right femur and in the radius and ulna of the right hand were obvious on the first visit. We should remember that several types of malignancies present in the lung, head and neck, esophagus, breast, and renal cells, can cause paraneoplastic hypercalcemia and mimic signs and symptoms of parathyroid adenoma [ 15 ]. In the last 30 years the most contemporary series show an incidence of 20% or less.…”

Hypercalcemia in Primary Hyperparathyroidism with Manifestations of Acute Pancreatitis

“…The first report of primary hyperparathyroidism associated with pancreatic lithiasis was published in 1947. [8,9] From data collected between 1950 and 1975 it was found that of 1153 patients with primary hyperparathyroidism, only 17 patients (1.5%) had pancreatitis, and alternative causes for pancreatitis could be described. in some patients.29 The prevalence of acute pancreatitis in primary hyperparathyroidism is estimated to be between 1.5 -7%.…”