Category: Other - Parathyroid

Monitor: 20

20 - PARATHYROID ADENOMA PRESENTING AS ACUTE RECURRENT PANCREATITIS

Thursday, Apr 25
12:30 PM – 1:00 PM

Objective : Acute pancreatitis is a medical emergency. The most common causes include alcohol and gall stones accounting for 70-90 % of cases. Primary hyperparathyroidism (PHPT) is a rare cause of pancreatitis with an estimated prevalence of 1.5-7%. Pancreatitis risk is 10-30 fold elevated in PHPT. We present a case of parathyroid adenoma presenting as acute recurrent pancreatitis in a 50 year old female. This case highlights the delay in the diagnosis of PHPT, in patients with acute pancreatitis as the sole clinical presentation, which can lead to complications causing increased morbidity and mortality.


Methods : N/A


Results : N/A


Discussion : A 50 year old, nonalcoholic female was referred to endocrinology clinic for evaluation of hypercalcemia. Her past medical history included 8 hospital admissions for acute pancreatitis and its complications, over a period of three years. Extensive workup done by Gastroenterology service ruled out structural, autoimmune and infectious etiologies of recurrent pancreatitis. She was not on any medications causing pancreatitis and chemistry revealed mild hypertriglyceridemia, which was medically treated. She continued to have recurrent attacks of pancreatitis even after undergoing empiric cholecystectomy. Review of medical records showed that her calcium levels ranged from 10.1- 12.4 mg/dl ( normal 8.5 - 10.2mg/dl ) during her acute pancreatitis episodes with PTH of 173 pg/ml ( normal 10 – 65 pg/ml ), Vitamin D was 11 ng/ml ( normal 20 - 100 ng/ml ). Patient denied any other symptoms of hypercalcemia, no history of kidney stones. She did not have a family history of hypercalcemia or parathyroid condition. Tc 99m Sestamibi scan was done which showed findings suspicious for left superior parathyroid adenoma. She underwent successful parathyroidectomy after which her calcium level remained normal and PTH was 38 pg/ml. She did not have any further attacks of pancreatitis but died soon after, during an admission for sepsis and multi organ failure, from chronic necrotic pancreatic debris as the source of sepsis.


Conclusion : Acute pancreatitis due to PHPT is a rare clinical occurrence. Patients may suffer two or more attacks of pancreatitis before a diagnosis of PHPT is made. Hypocalcemia is expected during acute pancreatitis and high normal to elevated calcium levels during these episodes should raise suspicion for primary hyperparathyroidism as cause of non biliary, non alcoholic recurrent pancreatitis. Early recognition of the entity and timely intervention is important to prevent fatal complications of recurrent pancreatitis.

Manisha Nukavarapu

Internal medicine resident
East tennessee state university
Johnson City, Tennessee

current IM resident, aspiring endocrinologist

Sathvika Reddy Gaddam

Internal medicine resident
East tennessee state university
Johnson City, Tennessee

None

vindhya Bharathi Sriramoju

Internal medicine resident
East tennessee state university
Johnson city, Tennessee

none

Saba Wasim Aziz

Assistant Professor
East tennessee state university
Johsnon city, Tennessee

none