Primary hyperparathyroidism: case report of a rare presentation of acute pancreatitis

Abstract

Introduction: Acute pancreatitis (AP) is a common inflammatory condition in surgical centers with an annual worldwide incidence of 4.9-73.4 cases per 100,000 inhabitants and its main causes are biliary calculus (40-70%) and alcoholism (25-35 %) followed by other unusual conditions, including hypertriglyceridemia and hypercalcemia. AP due to hypercalcemia, although rare, may represent a diagnostic difficulty and in many cases be diagnosed late. Objective: To report a rare case of acute pancreatitis caused by hypercalcemia. Case Report: The following report brings the medical history of a hospitalized patient four times in three years with complaint of abdominal pain. In the initial moment the diagnosis of alcoholic pancreatitis was made due to personal history of chronic alcoholism. At the last hospitalization the serum levels of calcium and parathyroid hormone (PTH) were 12,2 mmol/L and 178,8 pg/mL respectively, suggesting possible primary hyperparathyroidism (PHP). The hypothesis was confirmed with parathyroid scintigraphy and the patient underwent left parathyroidectomy and homolateral partial thyroidectomy, showing an improvement in serum PTH levels postoperatively as well as in his pancreatitis. Conclusion: Serum calcium dosing in patients with AP may be beneficial for early institution of treatment and relapse control in patients with PHP.