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Lackovic MM, Joksimovic BD, Babovic JC, Isenovic ER, Gluvic ZM. Recurrent acute pancreatitis as an initial presentation of primary hyperparathyroidism in juvenile patient. World J Clin Cases 2025; 13:100439. [DOI: 10.12998/wjcc.v13.i17.100439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 01/13/2025] [Accepted: 01/21/2025] [Indexed: 02/18/2025] Open
Abstract
Acute pancreatitis recurrence should always alert clinicians to primary hyperparathyroidism, especially in younger patients and those with a hereditary condition. When parathyroid abnormalities are adequately recognized and addressed, more recurrent attacks of acute pancreatitis are unlikely to occur.
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Affiliation(s)
- Milena M Lackovic
- Department of Endocrinology, University Clinical-Hospital Centre Zemun-Belgrade, Faculty of Medicine, University of Belgrade, Belgrade 11080, Serbia
| | - Bojan D Joksimovic
- Department of Endocrinology, University Clinical-Hospital Centre Zemun-Belgrade, Faculty of Medicine, University of Belgrade, Belgrade 11080, Serbia
| | - Jelena C Babovic
- Department of Geriatrics, University Clinical-Hospital Centre Zemun-Belgrade, Faculty of Medicine, University of Belgrade, Belgrade 11080, Serbia
| | - Esma R Isenovic
- Department of Radiobiology and Molecular Genetics, Vinča Institute of Nuclear Sciences - National Institute of the Republic of Serbia, University of Belgrade, Belgrade 11000, Serbia
| | - Zoran M Gluvic
- Department of Endocrinology, University Clinical-Hospital Centre Zemun-Belgrade, Faculty of Medicine, University of Belgrade, Belgrade 11080, Serbia
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2
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Danış F, Kudu E. Recurrent acute pancreatitis and primary hyperparathyroidism in patients presenting to the emergency department: Diagnostic challenges. World J Clin Cases 2025; 13:100741. [DOI: 10.12998/wjcc.v13.i17.100741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 01/19/2025] [Accepted: 01/21/2025] [Indexed: 02/18/2025] Open
Abstract
We read the article by Karim MM et al discusses the presentation of primary hyperparathyroidism as recurrent acute pancreatitis, a rare clinical condition in pediatric patients presenting to the emergency department. As emergency medicine clinicians, we frequently encounter diverse and complex cases, and such rare conditions pose significant challenges in the diagnostic process. This article will discuss the management and diagnostic approach of such cases encountered in the emergency department.
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Affiliation(s)
- Faruk Danış
- Department of Emergency Medicine, Bolu Abant İzzet Baysal University Medical School, Bolu 14000, Türkiye
| | - Emre Kudu
- Department of Emergency Medicine, Marmara University Pendik Training and Research Hospital, İstanbul 34899, Türkiye
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Luong TV, Le LD, Nguyen NVD, Dang HNN. Persistent challenges in the diagnosis of acute pancreatitis due to primary hyperparathyroidism during pregnancy. World J Gastroenterol 2025; 31:100973. [PMID: 39991684 PMCID: PMC11755251 DOI: 10.3748/wjg.v31.i7.100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 12/01/2024] [Accepted: 01/02/2025] [Indexed: 01/20/2025] Open
Abstract
In this manuscript, we provide critical commentary on the systematic review by Augustin et al, which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy. Although this is an infrequent complication, it poses severe risks to both maternal and fetal health. Due to its infrequent occurrence in clinical practice, this review is based on an analysis of individual case reports over the past 55 years. While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis, it is unique in that it has a sufficiently large sample size with statistically significant results. Our discussion focuses on the diagnostic challenges associated with this condition, which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels. We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.
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Affiliation(s)
- Thang Viet Luong
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue 530000, Viet Nam
| | - Linh Duy Le
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue 530000, Viet Nam
| | - Nam Van Duc Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue 530000, Viet Nam
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Karaca MO, Özyıldıran M, Savran MD, Başarır K, Yıldız HY. Brown tumors: Retrospective analysis of 26 cases. Arch Orthop Trauma Surg 2024; 144:2927-2934. [PMID: 38795187 PMCID: PMC11319420 DOI: 10.1007/s00402-024-05372-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/07/2024] [Indexed: 05/27/2024]
Abstract
INTRODUCTION Brown tumors are reactive osteolytic lesions caused by hyperparathyroidism. These rare lesions are non-neoplastic processes that result from bone resorption. The purpose of this study was to retrospectively review a 34-year experience with brown tumors in our institution. MATERIALS AND METHODS We retrospectively analyzed the records of 26 consecutive patients with brown tumor who were treated in our institution between May 1988 and October 2020, with a mean follow-up of 36,1 months. RESULTS 17 male (65,4%) and 9 female (34,6%) patients with a mean age of 41,6 were included in the study. Localized bone pain was present in 13 cases (50,0%) as the first presenting symptom. 3 patients (11,5%) presented with diffuse bone pain. 7 patients (26,9%) were diagnosed with brown tumor while being investigated for pathological fractures. The other 3 patients (11,5%) were diagnosed while being evaluated for hypercalcemia symptoms. 7 patients (26,9%) had solitary lesions, while 19 patients (73,1%) had multiple lesions. Pelvis, femur, ribs, tibia, proximal humerus and mandible were the most common sites of localization. 23 patients (88,5%) were diagnosed with primary hyperparathyroidism, while the other 3 patients (11,5%) had secondary hyperparathyroidism. A total of the 65 lesions, 23 (35.4%) underwent orthopedic surgery, and 42 (64.6%) were followed up conservatively after parathyroidectomy. Orthopedic surgery was performed in 21 of 26 patients, the other 5 cases were followed up conservatively. Intralesional curettage was performed in 19 cases (82,6%). The resulting cavity was filled with bone cement in 11 cases (47,8%). Bone grafting was applied in 8 cases (34,8%). No recurrence was observed in any of the patients. CONCLUSION The diagnosis of brown tumor begins with clinical suspicion. Endocrinology and general surgery consultation is important before surgery. Treatment of brown tumors requires a multidisciplinary approach.
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Affiliation(s)
- Mustafa Onur Karaca
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
| | - Mustafa Özyıldıran
- Department of Orthopedics and Traumatology, Sandıklı State Hospital, Afyonkarahisar, Turkey.
| | - Merve Dursun Savran
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
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Carsote M, Nistor C, Gheorghe AM, Sima OC, Trandafir AI, Nistor TVI, Sandulescu BA, Ciobica ML. Turning Points in Cross-Disciplinary Perspective of Primary Hyperparathyroidism and Pancreas Involvements: Hypercalcemia-Induced Pancreatitis, MEN1 Gene-Related Tumors, and Insulin Resistance. Int J Mol Sci 2024; 25:6349. [PMID: 38928056 PMCID: PMC11203827 DOI: 10.3390/ijms25126349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/13/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
We aimed to provide an in-depth analysis with respect to three turning points in pancreas involvement in primary hyperparathyroidism (PHP): hypercalcemia-induced pancreatitis (HCa-P), MEN1 (multiple endocrine neoplasia)-related neuroendocrine tumors (NETs), and insulin resistance (IR). This was a comprehensive review conducted via a PubMed search between January 2020 and January 2024. HCa-P (n = 9 studies, N = 1375) involved as a starting point parathyroid NETs (n = 7) or pancreatitis (n = 2, N = 167). Case report-focused analysis (N = 27) showed five cases of pregnancy PHP-HCa-P and three reports of parathyroid carcinoma (female/male ratio of 2/1, ages of 34 in women, men of 56). MEN1-NET studies (n = 7) included MEN1-related insulinomas (n = 2) or MEN1-associated PHP (n = 2) or analyses of genetic profile (n = 3), for a total of 877 MEN1 subjects. In MEN1 insulinomas (N = 77), the rate of associated PHP was 78%. Recurrence after parathyroidectomy (N = 585 with PHP) was higher after less-than-subtotal versus subtotal parathyroidectomy (68% versus 45%, p < 0.001); re-do surgery was 26% depending on surgery for pancreatic NETs (found in 82% of PHP patients). MEN1 pathogenic variants in exon 10 represented an independent risk factor for PHP recurrence. A single pediatric study in MEN1 (N = 80) revealed the following: a PHP rate of 80% and pancreatic NET rate of 35% and 35 underlying germline MEN1 pathogenic variants (and 3/35 of them were newly detected). The co-occurrence of genetic anomalies included the following: CDC73 gene variant, glucokinase regulatory protein gene pathogenic variant (c.151C>T, p.Arg51*), and CAH-X syndrome. IR/metabolic feature-focused analysis identified (n = 10, N = 1010) a heterogeneous spectrum: approximately one-third of adults might have had prediabetes, almost half displayed some level of IR as reflected by HOMA-IR > 2.6, and serum calcium was positively correlated with HOMA-IR. Vitamin D deficiency was associated with a higher rate of metabolic syndrome (n = 1). Normocalcemic and mildly symptomatic hyperparathyroidism (n = 6, N = 193) was associated with a higher fasting glucose and some improvement after parathyroidectomy. This multilayer pancreas/parathyroid analysis highlighted a complex panel of connections from pathogenic factors, including biochemical, molecular, genetic, and metabolic factors, to a clinical multidisciplinary panel.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Clinical Endocrinology V, “C.I. Parhon” National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Thoracic Surgery Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010242 Bucharest, Romania
| | - Ana-Maria Gheorghe
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.G.); (O.-C.S.); (A.-I.T.); (B.-A.S.)
| | - Oana-Claudia Sima
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.G.); (O.-C.S.); (A.-I.T.); (B.-A.S.)
| | - Alexandra-Ioana Trandafir
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.G.); (O.-C.S.); (A.-I.T.); (B.-A.S.)
| | - Tiberiu Vasile Ioan Nistor
- Department of Clinical Biochemistry, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Bianca-Andreea Sandulescu
- PhD Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.G.); (O.-C.S.); (A.-I.T.); (B.-A.S.)
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Mihai-Lucian Ciobica
- Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Internal Medicine I and Rheumatology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania
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Devgan Y, Mayilvaganan S, Mishra A, Chand G, Agarwal G, Mohindra S, Gupta S, Agarwal A. PHPT with Pancreatitis: Atypical Presentation of PHPT. Indian J Endocrinol Metab 2023; 27:513-518. [PMID: 38371176 PMCID: PMC10871018 DOI: 10.4103/ijem.ijem_169_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/17/2023] [Accepted: 09/04/2023] [Indexed: 02/20/2024] Open
Abstract
Background Primary hyperparathyroidism (PHPT) is rarely associated with the occurrence of acute or chronic pancreatitis, requiring complex perioperative management. This study aimed to assess the prevalence and disease characteristics of pancreatitis in PHPT. Materials and Methods This study is a clinicopathological analysis of the medical records of patients who were diagnosed with PHPT with pancreatitis between 1989 and 2021 in the Endocrine Surgery department, SGPGI, Lucknow. Results Out of 548 PHPT cases, 44 (8.03%) were found to be associated with pancreatitis. The mean age was 33.57 years (15-65 years); 5 were ≤20 years, while 26 were ≤30 years of age. There were 27 males and 17 females. Twenty-one cases were of acute (11 acute, nine recurrent acute, one acute on chronic), whereas 23 were of chronic pancreatitis (six chronic calcific pancreatitis). The major clinical presentation of PHPT with pancreatitis was abdominal pain (65.91%). The mean number of attacks per patient in recurrent acute pancreatitis was two. Mean PTH levels were 68.19 pmol/L. The mean tumor size (in the largest dimension) was 2.79 ± 1.4 cm while the mean tumor weight was 4.91 g. Nephrolithiasis was associated with 25 cases. An association with multiple endocrine neoplasia type 1 syndrome was seen in one case. The final histopathological diagnosis was parathyroid carcinoma in two, hyperplasia in three, and parathyroid adenoma in 39 cases. Normocalcemia was seen in 27.2%, hypercalcemic crisis in 15.9%, and 25% of patients required semi-emergency parathyroidectomy. The outcome was favorable in all, as none had any further attacks of pancreatitis. Conclusion In our study, the prevalence of pancreatitis in PHPT cases was 8.03%. The majority of patients were young. Normocalcemia was seen in 12 patients, so even if calcium levels are normal, PHPT should be suspected in young patients with pancreatitis. Parathyroidectomy resulted in the complete resolution of symptoms of pancreatitis in all 44 patients.
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Affiliation(s)
- Yuvraj Devgan
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareilly Road, Lucknow, Uttar Pradesh, India
| | - Sabaretnam Mayilvaganan
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareilly Road, Lucknow, Uttar Pradesh, India
| | - Anjali Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareilly Road, Lucknow, Uttar Pradesh, India
| | - Gyan Chand
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareilly Road, Lucknow, Uttar Pradesh, India
| | - Gaurav Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareilly Road, Lucknow, Uttar Pradesh, India
| | - Samir Mohindra
- Department of Gastromedicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareilly Road, Lucknow, Uttar Pradesh, India
| | - Sushil Gupta
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareilly Road, Lucknow, Uttar Pradesh, India
| | - Amit Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareilly Road, Lucknow, Uttar Pradesh, India
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Sarwal A, Abraham D, Kethineni R, Ramkumar N, Abraham J. Acute kidney injury, necrotizing pancreatitis and nephrocalcinosis: A rare presentation of primary hyperparathyroidism. Am J Med Sci 2023; 365:313-314. [PMID: 36543305 DOI: 10.1016/j.amjms.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/26/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Amara Sarwal
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Devaprabu Abraham
- Division of Endocrinology, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Rama Kethineni
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Nirupama Ramkumar
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Josephine Abraham
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, United States.
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Arhoun El Haddad I, Elmouhib A, Kachmar S, Elmezzioui S, Daoudi A, Melhaoui I, Mojahid A, Bkiyar H, kAMAOUI I, Housni B. Acute pancreatitis secondary to hypercalcemia in a patient with primary hyperparathyroidism: An uncommon association. Ann Med Surg (Lond) 2022; 84:104832. [PMID: 36582902 PMCID: PMC9793110 DOI: 10.1016/j.amsu.2022.104832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/24/2022] [Accepted: 10/30/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction An uncommon cause of acute pancreatitis, primary hyperparathyroidism accounts for less than 1% of cases. Case presentation A 41-year-old male with acute pancreatitis and hypercalcemia is described in this case. Primary hyperparathyroidism was discovered during the work-up for hypercalcemia. During the first 24 hours after his hospitalization, the patient was monitored in the intensive care unit, and after a positive outcome, he was discharged. Discussion Pancreatitis is a rare presentation of hyperparathyroidism. The first documented case of this association was by Erdheim in 1903 on a post-mortem study (2). Hyperparathyroidism is often only discovered after two or three episodes of recurrent pancreatitis (5), thankfully, in this case, the patient has been diagnosed from its first episode and eventually treated to prevent any other ones. hypercalcaemia leads to increase calcium in the pancreatic responsible for aggression of the pancreatic parenchyma and ducts, Other authors suggest that the pancreatic secretion in patients with hypercalcaemia is lower than normal, but the enzyme activity remains normal, resulting in the formation of protein plugs in the pancreatic ducts leading to their obstruction and self-digestion. Conclusion Hypercalcemia can cause acute pancreatitis. This report describes rare case of a patient with acute pancreatitis caused by hyperparathyroidism.
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Affiliation(s)
- Inass Arhoun El Haddad
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
| | - Amine Elmouhib
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
| | - Safaa Kachmar
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
| | - Sanae Elmezzioui
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
| | - Adelmounain Daoudi
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
| | - Imane Melhaoui
- Nephrology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
| | - Amal Mojahid
- Radiology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
| | - Houssam Bkiyar
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
- Mohammed First University Oujda, FMP Oujda, LAMCESM, Oujda, Morocco
| | - Imane kAMAOUI
- Radiology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
- Mohammed First University Oujda, FMP Oujda, LAMCESM, Oujda, Morocco
| | - Brahim Housni
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco
- Faculty of Medicine and Pharmacy, Mohammed 1 st University, Oujda, Morocco
- Mohammed First University Oujda, FMP Oujda, LAMCESM, Oujda, Morocco
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Qasimy J, Marres G, Massolt E, Ho-Han S. Rare case of pancreatitis treated by minimally invasive parathyroidectomy. BMJ Case Rep 2022; 15:e249385. [PMID: 39901387 PMCID: PMC9454063 DOI: 10.1136/bcr-2022-249385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/04/2022] Open
Abstract
Hypercalcaemia-induced pancreatitis is a rare and often overlooked phenomena. Despite hyperparathyroidism being a common cause of hypercalcaemia, the association between pancreatitis and hyperparathyroidism remains controversial and is often overlooked. Patients may however suffer serious complications when diagnosis and treatment of hyperparathyroidism are delayed due to insufficient awareness. We present a man in his 40s who was admitted with progressive epigastric pain due to pancreatitis. Blood tests showed elevated serum calcium levels, which led to extensive investigation. Further workups led to the diagnosis of primary hyperparathyroidism due to three parathyroid adenomas. The patient underwent minimally invasive parathyroidectomy, which was followed by an uncomplicated recovery and normal serum calcium levels.
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Affiliation(s)
- Jalda Qasimy
- Surgery, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | | | - Elkse Massolt
- Internal medicine, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Shiuw Ho-Han
- Radiology, Albert Schweitzer Hospital, Dordrecht, Netherlands
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Rashmi KG, Kamalanathan S, Sahoo J, Naik D, Mohan P, Pottakkat B, Kar SS, Palui R, Roy A. Primary hyperparathyroidism presenting as acute pancreatitis: An institutional experience with review of the literature. World J Gastrointest Pharmacol Ther 2022; 13:47-56. [PMID: 36051178 PMCID: PMC9297291 DOI: 10.4292/wjgpt.v13.i4.47] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/24/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) presenting as an initial manifestation of primary hyperparathyroidism (PHPT) is uncommon, and its timely diagnosis is crucial in preventing recurrent attacks of pancreatitis. AIM To determine the clinical, biochemical, and radiological profile of PHPT patients presenting as AP. METHODS This is a retrospective observational study, 51 consecutive patients admitted with the diagnosis of PHPT during January 2010 and October 2021 at a tertiary care hospital in Puducherry, India was included. The diagnosis of AP was established in the presence of at least two of the three following features: abdominal pain, levels of serum amylase or lipase greater than three times the normal, and characteristic features at abdominal imaging. RESULTS Out of the 51 consecutive patients with PHPT, twelve (23.52%) had pancreatitis [5 (9.80%) AP, seven (13.72%) chronic pancreatitis (CP)]. PHPT with AP (PHPT-AP) was more common among males with the presentation at a younger age (35.20 ± 16.11 vs 49.23 ± 14.80 years, P = 0.05) and lower plasma intact parathyroid hormone (iPTH) levels [125 (80.55-178.65) vs 519.80 (149-1649.55, P = 0.01)] compared to PHPT without pancreatitis (PHPT-NP). The mean serum calcium levels were similar in both PHPT-AP and PHPT-NP groups [(11.66 ± 1.15 mg/dL) vs (12.46 ± 1.71 mg/dL), P = 0.32]. PHPT-AP also presented with more gastrointestinal symptoms like abdominal pain, nausea, and vomiting with lesser skeletal and renal manifestations as compared to patients with PHPT-NP. CONCLUSION AP can be the only presenting feature of PHPT. Normal or higher serum calcium levels during AP should always draw attention towards endocrine causes like PHPT.
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Affiliation(s)
- K G Rashmi
- Department of Endocrinology, JIPMER, Puducherry 605006, India
| | | | | | | | - Pazhanivel Mohan
- Department of Medical Gastroenterology, JIPMER, Puducherry 605006, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, JIPMER, Puducherry 605006, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, JIPMER, Puducherry 605006, India
| | - Rajan Palui
- Department of Endocrinology, JIPMER, Puducherry 605006, India
| | - Ayan Roy
- Department of Endocrinology, JIPMER, Puducherry 605006, India
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11
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Zelano L, Locantore P, Rota CA, Policola C, Corsello A, Rossi ED, Rufini V, Zagaria L, Raffaelli M, Pontecorvi A. Parathyroid Carcinoma All-In-One, a Rare Life-Threatening Case With Multiple Systemic Manifestations: Case Report and Review of the Literature. Front Endocrinol (Lausanne) 2022; 13:881225. [PMID: 35872978 PMCID: PMC9300921 DOI: 10.3389/fendo.2022.881225] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
Parathyroid carcinoma (PC) is an extremely rare disease. Although it may occasionally occur in genetic syndromes, it is more often sporadic. It is usually associated with a consistent secretion of PTH, causing severe hypercalcemia and potentially all clinical conditions due to primary hyperparathyroidism. Management of PC can be challenging: some clinical, biochemical, and radiological features may be useful, but the final diagnosis of malignancy strictly relies on histological criteria. To date, radical surgery is the first-choice treatment and is the only effective therapy to control hypercalcemia and other clinical manifestations. On the other hand, chemo- or radiotherapy, local treatments, or novel drugs should be reserved for selected cases. We report an exceptionally unusual case of life-threatening PC, associated with several systemic manifestations: moderate pancreatitis, portal thrombosis, kidney stones, brown tumors, osteoporosis, hungry bone syndrome (HBS), chondrocalcinosis, neuropathy, and depression. The clinical case also represents an opportunity to provide a review of the recent literature, associated with a complete evaluation of the main diagnostic and therapeutic approaches.
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Affiliation(s)
- Lorenzo Zelano
- Department of Translational Medicine and Surgery, Unit of Endocrinology, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
| | - Pietro Locantore
- Department of Translational Medicine and Surgery, Unit of Endocrinology, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
- *Correspondence: Pietro Locantore,
| | - Carlo Antonio Rota
- Department of Translational Medicine and Surgery, Unit of Endocrinology, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
| | - Caterina Policola
- Department of Translational Medicine and Surgery, Unit of Endocrinology, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
| | - Andrea Corsello
- Department of Translational Medicine and Surgery, Unit of Endocrinology, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Institute of Pathology, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
| | - Vittoria Rufini
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
| | - Luca Zagaria
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
| | - Marco Raffaelli
- Department of Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
| | - Alfredo Pontecorvi
- Department of Translational Medicine and Surgery, Unit of Endocrinology, Università Cattolica del Sacro Cuore—Fondazione Policlinico “Gemelli” IRCCS, Rome, Italy
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HEPOKUR MN, ÖZKÖK M, ÖNDER A, ÇAĞLAR M, ÖZEMİR İA. A Rare Cause of Hypercalcemia : Two Cases of Parathyroid Adenoma. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.842622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Arora S, Singh P, Verma R, Mittal N, Sood A, Kalra S, Shanthaiah D. Primary Hyperparathyroidism Masquerading as Acute Pancreatitis. Horm Metab Res 2021; 53:377-381. [PMID: 34154028 DOI: 10.1055/a-1495-5573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute pancreatitis as an initial manifestation of primary hyperparathyroidism (PHPT) is a rare occurrence and timely diagnosis of PHPT is crucial in preventing repeat attack of pancreatitis. The study aimed at evaluating the clinico-radiological profile of patients admitted with acute pancreatitis as the index presentation of PHPT and to determine the factors associated with development of severe pancreatitis. This series included retrospective analysis of medical records of 30 patients admitted with acute pancreatitis as initial manifestation of PHPT. Additionally, we analyzed the data of another 30 patients admitted with PHPT but without any evidence of pancreatitis, to serve as control group. The mean age of the subjects was 44.9±13.9 years with male to female ratio of 1.30. The mean serum calcium level was 12.24±2.79 mg/dl and five (16.6%) patients had normocalcemia at time of presentation. Presence of nephrolithiasis was significantly associated with severe pancreatitis. One patient had refractory hypercalcemia associated with renal failure and was successfully managed with denosumab. Patients with PHPT associated with acute pancreatitis had significantly higher calcium levels and lower frequency of skeletal involvement as compared to PHPT patients without pancreatitis. PHPT masquerading as acute pancreatitis is rare and high index of suspicion is required to diagnose this condition especially in the presence of normocalcemia at presentation. Patients with PHPT associated pancreatitis had male preponderance, higher calcium levels, and lower frequency of skeletal involvement as compared to PHPT patients without pancreatitis.
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Affiliation(s)
- Saurabh Arora
- Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana, Punjab, India
| | - Parminder Singh
- Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana, Punjab, India
| | - Rohit Verma
- Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana, Punjab, India
| | - Naveen Mittal
- Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana, Punjab, India
| | - Ajit Sood
- Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana, Punjab, India
| | - Sanjay Kalra
- Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana, Punjab, India
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Mills K, Aniekwena J, Cochran T, Nsofor E, Bakinde N. A Rare Triad: Hypercalcemia-Induced Necrotizing Pancreatitis Presenting as Severe Diabetic Ketoacidosis. J Investig Med High Impact Case Rep 2021; 9:2324709621998477. [PMID: 33631992 PMCID: PMC7917841 DOI: 10.1177/2324709621998477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) typically occurs in persons above 45 years, with a
female predominance. PHPT induces a state of hypercalcemia, but acute pancreatitis is a
rare sequelae of this hypercalcemia. We report a case of a 31-year-old man with no known
medical history who presented in diabetic ketoacidosis with electrolyte abnormalities. His
clinical course progressed to multi-organ dysfunction despite correction of metabolic
derangements. Further workup led to the discovery of the uncommon triad by which
previously undiagnosed PHPT precipitated severe diabetic ketoacidosis.
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15
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Misgar RA, Bhat MH, Rather TA, Masoodi SR, Wani AI, Bashir MI, Wani MA, Malik AA. Primary hyperparathyroidism and pancreatitis. J Endocrinol Invest 2020; 43:1493-1498. [PMID: 32253728 DOI: 10.1007/s40618-020-01233-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/18/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The true association between primary hyperparathyroidism (PHPT) and pancreatitis continues to be controversial. In this study, we present clinical data, investigative profile, management and follow-up of PHPT patients with pancreatitis and compare this group with PHPT patients without pancreatitis. METHODS Records of 242 patients with PHPT managed at our center over 24 years were retrospectively analyzed for demographic and laboratory data. The diagnosis of pancreatitis was entertained in the presence of at least two of the three following features: abdominal pain, levels of serum amylase greater than three times the normal or characteristic features at imaging. RESULTS Fifteen (6.19%) of the 242 consecutive patients with PHPT had had pancreatitis. Fourteen patients (93.3%) had acute pancreatitis (AP), while one patient had chronic calcific pancreatitis. Over half (8 of 14) of the patients with AP had at least two episodes of pancreatitis. Pancreatitis was the presenting symptom in 14 (93.3%) patients. None of the pancreatitis cases had additional risk factors for pancreatitis. PHPT patients with pancreatitis had significantly higher serum calcium and ALP than PHPT patients without pancreatitis. After successful parathyroidectomy, 14 patients had no further attacks of pancreatitis during a median follow-up of 16 months (range 2-41 months), while recurrence of pancreatitis was seen in one patient. CONCLUSIONS We conclude that pancreatitis can be the only presenting complaint of PHPT. Our study highlights the importance of fully investigating for PHPT in any pancreatitis patient with high normal or raised serum calcium level, especially in the absence of other common causes of pancreatitis.
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Affiliation(s)
- R A Misgar
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
| | - M H Bhat
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - T A Rather
- Department of Nuclear Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - S R Masoodi
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - A I Wani
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - M I Bashir
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - M A Wani
- Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - A A Malik
- Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Ma YB, Hu J, Duan YF. Acute pancreatitis connected with hypercalcemia crisis in hyperparathyroidism: A case report. World J Clin Cases 2019; 7:2367-2373. [PMID: 31531333 PMCID: PMC6718780 DOI: 10.12998/wjcc.v7.i16.2367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The association between primary hyperparathyroidism (PHPT) and acute pancreatitis is rarely reported. Here we describe the process of acute pancreatitis-mediated PHPT induced by hypercalcemia in a male patient. Hypercalcemia induced by undiagnosed PHPT may be the causative factor in recurrent acute pancreatitis.
CASE SUMMARY We report a case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid adenoma in a 57-year-old man. The patient initially experienced a series of continuous gastrointestinal symptoms including abdominal distension, abdominal pain, nausea, vomiting, electrolyte disturbance, renal dysfunction, and acute pancreatitis. Due to prolonged hypercalcemia, the patient subsequently underwent surgical resection of the parathyroid adenoma. Two weeks after surgery, his serum calcium, amylase, and lipase concentrations were normal. The patient had a good recovery after a series of other relevant therapies.
CONCLUSION Acute pancreatitis as the first presentation is a rare clinical symptom caused by PHPT-induced hypercalcemia.
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Affiliation(s)
- Yi-Bo Ma
- Department of B-mode Ultrasound, The First People’s Hospital of Changzhou, Changzhou 213003, Jiangsu Province, China
| | - Jun Hu
- Department of Hepatobiliary Surgery, The First People’s Hospital of Changzhou, Changzhou 213003, Jiangsu Province, China
| | - Yun-Fei Duan
- Department of Hepatobiliary Surgery, The First People’s Hospital of Changzhou, Changzhou 213003, Jiangsu Province, China
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Research Progress on the Relationship Between Acute Pancreatitis and Calcium Overload in Acinar Cells. Dig Dis Sci 2019; 64:25-38. [PMID: 30284136 DOI: 10.1007/s10620-018-5297-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/01/2018] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis is a human disease with multiple causes that leads to autodigestion of the pancreas. There is sufficient evidence to support the key role of sustained increase in cytosolic calcium concentrations in the early pathogenesis of the disease. To clarify the mechanism of maintaining calcium homeostasis in the cell and pathological processes caused by calcium overload would help to research directly targeted therapeutic agents. We will specifically review the following: intracellular calcium homeostasis and regulation, the occurrence of calcium overload in acinar cells, the role of calcium overload in the pathogenesis of AP, the treatment strategy proposed for calcium overload.
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18
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Minisola S, Gianotti L, Bhadada S, Silverberg SJ. Classical complications of primary hyperparathyroidism. Best Pract Res Clin Endocrinol Metab 2018; 32:791-803. [PMID: 30665547 DOI: 10.1016/j.beem.2018.09.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Traditionally, classical complications of primary hyperparathyroidism are mainly represented by skeletal, kidney and gastrointestinal involvement. The old picture of osteitis fibrosa cystica is no longer commonly seen, at least in the western world. However, new imagining techniques have highlighted deterioration of skeletal tissue in patients with primary hyperparathyroidism not captured by traditional DXA measurement. Concerning the kidney, the most common consequences of excessive parathyroid hormone secretion are hypercalciuria and kidney stones; however, the exact pathogenesis of urinary stone formation is still unknown. The 2013 International Congress on the management of Asymptomatic Primary Hyperparathyroidism, emphasized the role of imaging techniques for early discovery of both skeletal and renal complications in asymptomatic patients. Gastrointestinal manifestations include acid-peptic disease, constipation, pancreatitis and gall stone disease. More studies are needed in this area to find the exact pathophysiological mechanism underlying these manifestations and the effect of parathyroid surgery.
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Affiliation(s)
- Salvatore Minisola
- Department of Internal Medicine and Medical Disciplines, "Sapienza", Rome University, Italy.
| | - Laura Gianotti
- SC Endocrinologia Diabetologia e Metabolismo, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
| | - Sanjay Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
| | - Shonni J Silverberg
- Columbia University Medical College of Physicians & Surgeons, New York, USA.
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Cetani F, Barone S, Marcocci C. Acute pancreatitis as the first manifestation in a young boy with primary hyperparathyroidism. Endocrine 2018; 62:267-268. [PMID: 29704155 DOI: 10.1007/s12020-018-1602-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Affiliation(s)
| | - Sara Barone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Marcocci
- University Hospital of Pisa, Endocrine Unit 2, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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20
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Gao Y, Yu C, Xiang F, Xie M, Fang L. Acute pancreatitis as an initial manifestation of parathyroid carcinoma: A case report and literature review. Medicine (Baltimore) 2017; 96:e8420. [PMID: 29095277 PMCID: PMC5682796 DOI: 10.1097/md.0000000000008420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Parathyroid carcinoma is a rare endocrine malignancy. Acute pancreatitis as an initial manifestation of parathyroid carcinoma has been rarely reported. PATIENT CONCERNS A 22-year-old woman was admitted to emergency room with a sudden attack of severe epigastric pain. DIAGNOSES Acute pancreatitis was diagnosed as elevated levels of serum amylase. During the work-up for acute pancreatitis, patient's abnormally increased serum calcium and bones destruction revealed by abdominal computed tomography (CT) scan raised the suspicion of hyperparathyroidism or malignancy. Elevated serum parathyroid hormone (PTH) levels, parathyroid ultrasound and scintigraphy gave rise to the diagnosis of primary hyperparathyroidism (PHPT) due to a left parathyroid tumor. INTERVENTIONS The patient was given a complete tumor excision. After the surgery, parathyroid carcinoma with capsular and vascular invasion was confirmed histologically. A second surgery was then performed, including resection of the ipsilateral thyroid lobe and anterior cervical nodes. OUTCOMES Serum calcium and PTH levels returned to normal postoperatively. LESSONS Acute pancreatitis accompanied with hypercalcemia should always raise the suspicion of PHPT. The spicule sign, which always suggests the infiltrating pattern growth of tumor, was neglected at first and was observed during a second review of the ultrasound images postoperatively. This specific feature may be predictive for the preoperative diagnosis of parathyroid carcinoma or at least suspicion of malignancy.
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Ahmad S, Kuraganti G, Steenkamp D. Hypercalcemic crisis: a clinical review. Am J Med 2015; 128:239-45. [PMID: 25447624 DOI: 10.1016/j.amjmed.2014.09.030] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/27/2014] [Accepted: 09/29/2014] [Indexed: 02/01/2023]
Abstract
Hypercalcemia is a common metabolic perturbation. However, hypercalcemic crisis is an unusual endocrine emergency, with little clinical scientific data to support therapeutic strategy. We review the relevant scientific English literature on the topic and review current management strategies after conducting a PubMed, MEDLINE, and Google Scholar search for articles published between 1930 and June 2014 using specific keywords: "hypercalcemic crisis," "hyperparathyroid crisis," "parathyroid storm," "severe primary hyperparathyroidism," "acute hyperparathyroidism," and "severe hypercalcemia" for articles pertaining to the diagnosis, epidemiology, clinical presentation, and treatment strategies. Despite extensive clinical experience, large and well-designed clinical studies to direct appropriate clinical care are lacking. Nonetheless, morbidity and mortality rates have substantially decreased since early series reported almost universal fatality. Improved outcomes can be attributed to modern diagnostic capabilities, leading to earlier diagnosis, along with the recognition that primary hyperparathyroidism is the most common etiology for hypercalcemic crisis. Hypercalcemic crisis is an unusual endocrine emergency that portends excellent outcomes if rapid diagnosis, medical treatment, and definitive surgical treatment are expedited.
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Affiliation(s)
- Shazia Ahmad
- Department of Medicine, Boston Medical Center, Boston, Mass
| | | | - Devin Steenkamp
- Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine and Boston Medical Center, Boston, Mass.
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Abstract
The parathyroid gland was first described by Sir Richard Owen. Ivor Sandstrom coined the term glandulae parathyroidiae. Vassale and Generali Francesco observed that tetany occurs following parathyroidectomy. Harald Salvesen firmly established the relationship of the parathyroid gland to calcium metabolism. A patient with skeletal disease and a tumor near the parathyroid gland was described by Max Askanazy in 1904. Schlagenhaufer suggested in 1915 that in an attempt to cure bone disease, solitary parathyroid enlargement, if present, should be excised. The term hyperparathyroidism (HPT) was coined by Henry Dixon and colleagues. The parathyroid surgeries on Albert J. and Charles Martell were the first experience with successful parathyroidectomy. From a grossly symptomatic disease of bones, stones, abdominal groans, and psychic moans, HPT has evolved into asymptomatic HPT. Improvements in knowledge about the pathology of parathyroid diseases, including the genetic basis of HPT, and advances in the surgical techniques have brought about changes in the management of HPT over the decades.
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Affiliation(s)
- N. Dorairajan
- The Tamilnadu Dr MGR Medical University, Chennai; Madras Medical College, Chennai; and Apollo Hospitals, Chennai; Tamil Nadu, India
| | - P.V. Pradeep
- Department of Endocrine Surgery, Narayana Medical College & Super Speciality Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
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Padma S, Sundaram PS. Parathyroid scintigraphy, histopathology correlation in patients with tropical pancreatitis and coexisting primary hyperparathyroidism. Indian J Nucl Med 2013; 28:5-10. [PMID: 24019667 PMCID: PMC3764697 DOI: 10.4103/0972-3919.116796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Tropical pancreatitis (TP) is a juvenile, non-alcoholic type of chronic pancreatitis and is highly prevalent in Kerala, India. Increasing prevalence of TP and its varied manifestations prompted us to undertake this retrospective analysis. We attempted to study the incidence of TP in patients with primary hyperparathyroidism (PHPT) and correlate with calcium levels, scintigraphy and histopathology findings. Materials and Methods: Records of 44 hypercalcemic patients with raised parathormone (PTH) were analyzed. Clinical, biochemical and imaging findings were noted to look for diabetes mellitus and pancreatitis. All patients underwent dual phase 99m Technetium methoxy isobutyl isonitrile parathyroid scintigraphy in our department between January 2007 and 2010. Gamma probe assisted minimally invasive parathyroidectomy was performed. Histopathological correlation was obtained in all patients. Results: Our study shows 18% (8/44 patients) incidence of TP in patients with PHPT (compared to 7% reported in 1970's) in Kerala. Results show involvement of middle aged, non-alcoholic males. No direct association between severity of diabetes, pancreatitis and PHPT was noted in our series. Parathyroid adenoma was the most common underlying pathology. All TP patients’ clinical outcome improved post parathyroidectomy. TP patients with PHPT demonstrated adenomas, mainly composed of oxyphilic cells. Non pancreatitis group interestingly showed a varied picture of adenoma, hyperplasia with predominance of chief cells histologically. Conclusion: There is a 2.6 fold increase in the incidence of TP (18%) in patients with PHPT. Hypercalcemia may be the causative factor leading to TP in PHPT patients in our limited series. The data suggests a causal association between pancreatitis and PHPT. Patients presenting with either one or a combination of hypercalcemia, pancreatic dysfunction or raised PTH need to be thoroughly evaluated as their management is interlinked.
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Affiliation(s)
- Subramanyam Padma
- Department of Nuclear Medicine and PET CT, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
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Abstract
Acute pancreatitis is a medical emergency. Alcohol and gallstones are the most common etiologies accounting for 60%-75% cases. Other important causes include postendoscopic retrograde cholangiopancreatography procedure, abdominal trauma, drug toxicity, various infections, autoimmune, ischemia, and hereditary causes. In about 15% of cases the cause remains unknown (idiopathic pancreatitis). Metabolic conditions giving rise to pancreatitis are less common, accounting for 5%-10% cases. The causes include hypertriglyceridemia, hypercalcemia, diabetes mellitus, porphyria, and Wilson's disease. The episodes of pancreatitis tend to be more severe. In cases of metabolic pancreatitis, over and above the standard routine management of pancreatitis, careful management of the underlying metabolic abnormalities is of paramount importance. If not treated properly, it leads to recurrent life-threatening bouts of acute pancreatitis. We hereby review the pathogenesis and management of various causes of metabolic pancreatitis.
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Affiliation(s)
- Sunil Kumar Kota
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
| | - S.V.S. Krishna
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
| | - Sandeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh, India
| | - Kirtikumar D. Modi
- Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India
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25
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Frick TW. The role of calcium in acute pancreatitis. Surgery 2012; 152:S157-63. [PMID: 22906890 DOI: 10.1016/j.surg.2012.05.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 02/06/2023]
Abstract
Until recently, it was unclear whether calcium is more than a bystander in the development of acute pancreatitis. Now important evidence has been accumulated supporting a pivotal role of intracellular levels of calcium in the early pathogenesis of the disease. A sustained increase of cytosolic calcium concentrations, as observed in various models of acute pancreatitis, was identified as sabotaging crucial cellular defense mechanisms and initiating premature trypsinogen activation. These processes lead the acinar cell to necrosis, with spillage of activated proteases into the interstitial space, affecting surrounding acinar cells and initiating a vicious circle that ends in macroscopic acute pancreatitis and systemic inflammatory response syndrome. Comprehensive knowledge of the pathobiology of cytosolic calcium in the pancreatic acinar cell is leading to the understanding of coherent molecular pathways of early events in the pathogenesis of acute pancreatitis and is opening horizons for research into directly targeted therapeutic agents.
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Affiliation(s)
- Thomas W Frick
- Department of Surgery, University of Zürich, Wilhofstrasse, Zollikerberg, Switzerland.
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Abboud B, Daher R, Boujaoude J. Digestive manifestations of parathyroid disorders. World J Gastroenterol 2011; 17:4063-4066. [PMID: 22039319 PMCID: PMC3203356 DOI: 10.3748/wjg.v17.i36.4063] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/25/2011] [Accepted: 04/02/2011] [Indexed: 02/06/2023] Open
Abstract
The parathyroid glands are the main regulator of plasma calcium and have a direct influence on the digestive tract. Parathyroid disturbances often result in unknown long-standing symptoms. The main manifestation of hypoparathyroidism is steatorrhea due to a deficit in exocrine pancreas secretion. The association with celiac sprue may contribute to malabsorption. Hyperparathyroidism causes smooth-muscle atony, with upper and lower gastrointestinal symptoms such as nausea, heartburn and constipation. Hyperparathyroidism and peptic ulcer were strongly linked before the advent of proton pump inhibitors. Nowadays, this association remains likely only in the particular context of multiple endocrine neoplasia type 1/Zollinger-Ellison syndrome. In contrast to chronic pancreatitis, acute pancreatitis due to primary hyperparathyroidism is one of the most studied topics. The causative effect of high calcium level is confirmed and the distinction from secondary hyperparathyroidism is mandatory. The digestive manifestations of parathyroid malfunction are often overlooked and serum calcium level must be included in the routine workup for abdominal symptoms.
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Biondi A, Persiani R, Marchese M, Cananzi F, D’Ugo D. Acute pancreatitis associated with primary hyperparathyroidism. Updates Surg 2011; 63:135-8. [DOI: 10.1007/s13304-011-0048-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 01/14/2011] [Indexed: 01/08/2023]
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Lenz JI, Jacobs JM, Op de Beeck B, Huyghe IA, Pelckmans PA, Moreels TG. Acute necrotizing pancreatitis as first manifestation of primary hyperparathyroidism. World J Gastroenterol 2010; 16:2959-62. [PMID: 20556845 PMCID: PMC2887595 DOI: 10.3748/wjg.v16.i23.2959] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma. Initially the acute pancreatitis was treated conservatively. The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst. Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity, it is very uncommon. The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known, although some mechanisms have been proposed. It is important to treat the provoking factor. Therefore, the cause of hypercalcemia should be identified early. Surgical resection of the parathyroid adenoma is the ultimate therapy.
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30
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Kumar R. A Case of Chronic Pancreatitis Due to Hyper Parathyroidism. APOLLO MEDICINE 2010. [DOI: 10.1016/s0976-0016(12)60009-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lanitis S, Sivakumar S, Zaman N, Westerland O, Al Mufti R, Hadjiminas DJ. Recurrent acute pancreatitis as the first and sole presentation of undiagnosed primary hyperparathyroidism. Ann R Coll Surg Engl 2010; 92:W29-31. [PMID: 20353632 PMCID: PMC5696903 DOI: 10.1308/147870810x476746] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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.
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Affiliation(s)
- Sophocles Lanitis
- General Surgery Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, UK.
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Khoo TK, Vege SS, Abu-Lebdeh HS, Ryu E, Nadeem S, Wermers RA. Acute pancreatitis in primary hyperparathyroidism: a population-based study. J Clin Endocrinol Metab 2009; 94:2115-8. [PMID: 19318456 PMCID: PMC2730346 DOI: 10.1210/jc.2008-1965] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT The association between acute pancreatitis and primary hyperparathyroidism (PHPT) is controversial. OBJECTIVE The aim of the study was to address the incidence and disease characteristics of acute pancreatitis in PHPT from a large inception cohort of community residents. DESIGN AND SETTING Patients with acute pancreatitis were identified in an Olmsted County, Minnesota, cohort of PHPT subjects diagnosed from 1965-2001 and compared to matched control subjects. MAIN OUTCOME MEASURES The estimated rate of developing acute pancreatitis was calculated by person-years method. Cox models assessed the effect of PHPT disease status on the development of acute pancreatitis. RESULTS Of 684 patients with PHPT, 10 patients (1.5%) developed acute pancreatitis, compared to 32 of 1364 control patients (2.3%). The estimated rate of development of acute pancreatitis in PHPT was 114 per 100,000 person-years, compared to 140 per 100,000 person-years in control subjects (P = 0.56). The estimated hazard ratio of acute pancreatitis for PHPT relative to the control subjects was 0.84 (P = 0.89). The majority of subjects with PHPT and acute pancreatitis were women (n = 7), and the mean age was 70.6 yr at the time of acute pancreatitis. PHPT was present an average of 137 months before the development of acute pancreatitis, and contributing causes for acute pancreatitis were in identified in four patients. Maximal serum calcium levels in PHPT were not significantly associated with the development of acute pancreatitis. CONCLUSIONS Acute pancreatitis was not increased in community patients with PHPT, and therefore, there does not appear to be a causal relationship between PHPT and acute pancreatitis.
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Affiliation(s)
- Teck Kim Khoo
- Division of Endocrinology, Metabolism, and Nutrition, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Takimoto T, Hara H. Mediastinal pancreatic pseudocysts that were resolved following parathyroidectomy for primary hyperparathyroidism. Intern Med 2009; 48:1671-6. [PMID: 19755772 DOI: 10.2169/internalmedicine.48.2360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hyperparathyroidism is a rare cause of pancreatic inflammatory disease, however their causal relationship has been widely accepted. The appropriate therapy is less clear when patients with hyperparathyroidism-associated pancreatitis develop complications such as pseudocysts. We describe a 51-year-old woman with primary hyperparathyroidism who developed pancreatic pseudocysts extending into the mediastinum. After the correction of hyperparathyroidism by removal of a parathyroid adenoma, the pseudocysts were resolved and no additional treatment was necessary. In patients with primary hyperparathyroidism who develop uncomplicated pancreatic pseudocysts, surgical correction of primary hyperparathyroidism may precede the interventional treatment on the pancreas when possible.
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Affiliation(s)
- Takayuki Takimoto
- Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan.
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Bhadada SK, Udawat HP, Bhansali A, Rana SS, Sinha SK, Bhasin DK. Chronic pancreatitis in primary hyperparathyroidism: comparison with alcoholic and idiopathic chronic pancreatitis. J Gastroenterol Hepatol 2008; 23:959-64. [PMID: 17683498 DOI: 10.1111/j.1440-1746.2007.05050.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary hyperparathyroidism is a rare cause of chronic pancreatitis and there is a paucity of data on this interesting association. There is also no data comparing the clinical profile of chronic pancreatitis secondary to primary hyperparathyroidism with that of alcohol related and idiopathic chronic pancreatitis. METHODS The clinical and biochemical spectrum of chronic pancreatitis secondary to primary hyperparathyroidism was evaluated retrospectively and compared with nine age-matched patients with alcohol related and idiopathic chronic pancreatitis. RESULTS Renal colic, nephrolithiasis, nephrocalcinosis, bone disease, palpable neck nodule, and psychiatric abnormality were significantly more common in chronic pancreatitis due to hyperparathyroidism in comparison to alcoholic and idiopathic groups. The corrected calcium (10.8 +/- 0.9 vs 9.3 +/- 0.6 vs 9.2 +/- 0.8 mg/dL; P = 0.001) and intact parathormone (425 +/- 130 [SE]vs 22.2 +/- 14.3 [SE]vs 30 +/- 27.3 [SE] pg/mL; P = 0.009) levels were significantly elevated, while levels of serum phosphate were significantly less (3.1 +/- 0.4 vs 3.9 +/- 0.5 vs 3.4 +/- 0.7 mg/dL, respectively; P = 0.04) in chronic pancreatitis due to hyperparathyroidism in comparison to the alcoholic and idiopathic groups. No significant difference was observed in the frequency of steatorrhea, diabetes mellitus, pancreatic calcification, and pseudocyst between the three groups. Six out of nine patients underwent parathyroidectomy and none had recurrence of pancreatic pain over 14.3 +/- 13.8 months. CONCLUSIONS Chronic pancreatitis due to hyperparathyroidism has important characteristics in its biochemical and clinical manifestations. Parathyroidectomy relieves pancreatic pain in majority of patients.
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Affiliation(s)
- Sanjay K Bhadada
- Department of Endocrinology and Metabolism, Post Graduate Institute of Medical Education (PGIMER), Chandigarh, India
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Hyperparathyroid crisis: use of bisphosphonates as a bridge to parathyroidectomy. J Am Coll Surg 2008; 206:1106-15. [PMID: 18501807 DOI: 10.1016/j.jamcollsurg.2007.11.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Revised: 11/07/2007] [Accepted: 11/12/2007] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hyperparathyroid crisis is an uncommon, potentially lethal condition for which emergent parathyroidectomy has been advocated. STUDY DESIGN The manifestations of hyperparathyroid crisis and outcomes of bisphosphonate-based therapy and delayed parathyroidectomy were determined and compared with cases from a review of the literature. Laboratory indices and gland weights were compared with those from patients with primary hyperparathyroidism without crisis. RESULTS Of the 292 patients operated on for hyperparathyroidism, 8 (2.8%) had hyperparathyroid crisis, consistent with rates of 1.6% to 6% reported in the literature. Hyperparathyroid crisis was manifested by vomiting, nausea, or both (n=6); abdominal pain (n=3); mental status changes (n=3); pancreatitis (n=2); bone pain, osteolytic lesions, or both (n=2); electrocardiogram changes (n=1); and an acute conversion disorder (n=1). Isotonic sodium chloride and furosemide, in combination with a bisphosphonate drug in 7 of 8 patients, resulted in a calcium decline from 16.2+/-1.6 mg/dL to 11.8+/-1.6 mg/dL, with resolution of electrocardiogram and mental status changes, and pancreatitis before resection of an adenoma (n=7) or carcinoma (n=1). Patients with hyperparathyroid crisis had higher parathyroid hormone levels (691.7 +/-662.4 pg/mL versus 172.6 +/-147.5 pg/mL; p=0.062), larger tumor weights (7.5 +/-8.4 g versus 1.6 +/-2.1 g; p=0.085), and lower postoperative calcium levels (7.3 +/-1.6 mg/dL versus 8.7+/-0.9 mg/dL; p=0.035) than patients without crisis. Four (50%) of the 8 tumors were found in ectopic locations. There was no mortality from hyperparathyroid crisis, compared with a 7% mortality rate for cases reported in the literature since 1978. CONCLUSIONS Rehydration, calciuresis, and bisphosphonate therapy are effective in correcting life-threatening manifestations of hyperparathyroid crisis, providing an effective bridge to parathyroidectomy.
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Kanno K, Hikichi T, Saito K, Watanabe K, Takagi T, Shibukawa G, Wakatsuki T, Imamura H, Takahashi Y, Sato A, Sato M, Irisawa A, Obara K, Ohira H. A case of esophageal small cell carcinoma associated with hypercalcemia causing severe acute pancreatitis. Fukushima J Med Sci 2007; 53:51-60. [PMID: 17957966 DOI: 10.5387/fms.53.51] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 60-year-old woman was diagnosed with esophageal small cell carcinoma in October 2004 and received chemotherapy. However, the tumor grew gradually and multiple bone metastases occurred. Anorexia, nausea, emesis, numbness in both hands, and disturbed consciousness developed at the end of January 2006, and the patient was admitted to Fukushima Medical University Hospital. Abdominal pain, marked hypercalcemia and hyperamylasemia were noted and the patient was diagnosed with severe acute pancreatitis. Because the level of blood parathyroid hormone-related protein was elevated, we considered that esophageal small cell carcinoma caused human hypercalcemia of malignancy and that metastatic bone tumors caused local osteolytic hypercalcemia, eventually leading to severe acute pancreatitis. This is an extremely rare case of esophageal small cell carcinoma associated with hypercalcemia causing severe acute pancreatitis.
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Affiliation(s)
- Kaori Kanno
- Department of Internal Medicine II, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan.
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Abouzahir A, Baite A, Azennag M, Bouchama R, Nzouba L. Pancréatite chronique calcifiante révélant une hyperparathyroïdie primaire. Rev Med Interne 2006; 27:640-2. [PMID: 16806594 DOI: 10.1016/j.revmed.2006.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 03/30/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The association of pancreatitis and hyperparathyroidism is rare. CASE RECORD A 41-year-old man had consulted for a strong abdominal pain reliant to a chronic calcifying pancreatitis. A major hypercalcaemia led to a primary hyperparathyroidism diagnosis. The evolution was favourable after parathyroid adenoma surgery. DISCUSSION The hypercalcaemia activate the transformation of trypsinogen into trypsin which is toxic for the pancreas. The role of parathyroid hormone remains unclear.
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Affiliation(s)
- A Abouzahir
- Service de médecine interne, 5e hôpital militaire, BP 1052, 81000 Guelmim, Maroc.
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Solis-Caxaj CA, Jafari M, Latteux C, Galleri D, Pattou F, Carnaille B, Franceschi A, Proye C. [Early postoperative hyperamylasemia after parathyroidectomy for primary hyperparathyroidism]. ACTA ACUST UNITED AC 2004; 129:269-72. [PMID: 15220099 DOI: 10.1016/j.anchir.2003.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Accepted: 10/15/2003] [Indexed: 11/18/2022]
Abstract
AIM The postoperative pancreatitis was a classical complication in the historical series of primary hyperparathyroidism (HPT), but the causal association was never demonstrated and even recent studies denied it. The aim of this study was to determine the augmentation of postoperative amylasemia, and its possible clinical traduction in patients operated for primary HPT. MATERIAL AND METHODS Fifty consecutive patients operated for cure of a primary HPT were included in this study. Total amylase, as well as isoenzyme fractions P (pancreatic) and S (salivary), calcium, phosphorus and intact PTH serum concentrations were determined on the days prior and after parathyroidectomy. Fifteen normocalcemic patients operated for secondary HPT constituted the control group. RESULTS The study deals with 42 female and eight male patients, their mean age was 58.5 years (range 19-89 years). All patients underwent parathyroidectomy for adenoma or hyperplasia. No patient had pancreatitis before parathyroidectomy. Postoperative amylasemia developed in four patients (8%), one with increased total amylase and P fraction, one with only increased total amylase, and two with increased total amylase and S fraction. No patients exhibited abdominal symptoms suggesting acute pancreatitis in the postoperative period. There was no correlation between pre- and post-operative calcium serum levels and pre- and post-operative amylasemia. In the secondary HPT group no significant diminution of the total amylasemia or of P and S fractions were observed. CONCLUSIONS These results indicate that acute pancreatitis is an exceptional postoperative complication of primary HPT nowadays. The 8% incidence reported in the present study matches the incidence of hyperamylasemia reported postoperatively in non-abdominal or non-parathyroid surgery.
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Affiliation(s)
- C A Solis-Caxaj
- Service de chirurgie générale et endocrinienne, hôpital Huriez, CHU de Lille, 59037 Lille, France.
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Affiliation(s)
- Michael O Stormon
- Division of Gastroenterology and Nutrition, Department of Pediatrics, University of Toronto and Programs in Genetics, Genomic Biology and Integrative Biology, the Research Institute, the Hospital for Sick Children, Toronto, Canada
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Abstract
The utilization of recent advances in molecular and genomic technologies and progress in pancreatic imaging techniques provided remarkable insight into genetic, environmental, immunologic, and pathobiological factors leading to chronic pancreatitis. Translation of these advances into clinical practice demands a reassessment of current approaches to diagnosis, classification, and staging. We conclude that an adequate pancreatic biopsy must be the gold standard against which all diagnostic approaches are judged. Although computed tomography remains the initial test of choice for the diagnosis of chronic pancreatitis, the roles of endoscopic retrograde pancreatography, endoscopic ultrasonography, and magnetic resonance imaging are considered. Once chronic pancreatitis is diagnosed, proper classification becomes important. Major predisposing risk factors to chronic pancreatitis may be categorized as either (1) toxic-metabolic, (2) idiopathic, (3) genetic, (4) autoimmune, (5) recurrent and severe acute pancreatitis, or (6) obstructive (TIGAR-O system). After classification, staging of pancreatic function, injury, and fibrosis becomes the next major concern. Further research is needed to determine the clinical and natural history of chronic pancreatitis developing in the context of various risk factors. New methods are needed for early diagnosis of chronic pancreatitis, and new therapies are needed to determine whether interventions will delay or prevent the progression of the irreversible damage characterizing end-stage chronic pancreatitis.
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Affiliation(s)
- B Etemad
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Abstract
Cope showed in 1957 that pancreatitis may be the presenting symptom in hyperparathyroidism. Since then, the literature has reported a coincidence of primary hyperparathyroidism and pancreatitis between 1% and 19%, but the true relationship has not been fully established. When severe pancreatitis follows parathyroidectomy, a condition familiar to parathyroid surgeons, reports are mostly anecdotal and by many authors considered to be coincidental. We present the case history of a 58-year-old man with a longstanding history of untreated primary hyperparathyroidism who developed severe pancreatitis immediately after removal of a 400-mg parathyroid adenoma. He was the first in a series of 108 operated patients to develop this complication. His preoperative levels of parathormone and serum calcium were the highest in our material. We believe that pancreatitis after parathyroidectomy is a real but rare complication that might be predicted by preoperative high values of serum calcium and parathormone.
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Affiliation(s)
- O Mjåland
- Dept. of Surgery, Vestfold Central Hospital, Tønsberg, Norway
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JAWAHEER S. Primary hyperparathyroidism. acute urinary infection and pancreatits. BRITISH MEDICAL JOURNAL 1998; 1:450-1. [PMID: 14041658 PMCID: PMC2123981 DOI: 10.1136/bmj.1.5328.450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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STIEL MC, PIPER DW. Pancreatitis associated with hyperparathyroidism. Report of a case. ACTA ACUST UNITED AC 1998; 7:850-6. [PMID: 13917216 DOI: 10.1007/bf02231921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kondo Y, Nagai H, Kasahara K, Kanazawa K. Primary hyperparathyroidism and acute pancreatitis during pregnancy. Report of a case and a review of the English and Japanese literature. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1998; 24:43-7. [PMID: 9746889 DOI: 10.1007/bf02787530] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The simultaneous occurrence of primary hyperparathyroidism (PHPT) and pancreatitis during pregnancy is very rare. We present a case of concurrent PHPT and pancreatitis in pregnancy and review 13 cases reported in the English and Japanese literature. Two maternal and three fetal deaths occurred. Mortality seemed to be related to delayed resection of the parathyroid tumor. Morphologically, severe pancreatitis was only seen in three cases, whereas even edematous or focal pancreatitis caused the same symptoms as clinically severe pancreatitis. Acute pancreatitis should be kept in mind in the differential diagnosis of unexplained nausea and abdominal pain during pregnancy, and hyper-or normocalcemia in the severe form of pancreatitis should be a clue to concurrent PHPT.
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Affiliation(s)
- Y Kondo
- Department of Surgery, Jichi Medical School, Tochigi, Japan
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Carnaille B, Oudar C, Pattou F, Combemale F, Rocha J, Proye C. Pancreatitis and primary hyperparathyroidism: forty cases. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:117-9. [PMID: 9494002 DOI: 10.1111/j.1445-2197.1998.tb04719.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pancreatitis is associated with primary hyperparathyroidism (PHPT) in 1.5-7% of cases. The relationship of cause and effect between the two diseases has been debated. METHODS To evaluate this relationship, the clinical, biochemical and pathological data on 1435 patients operated on for hyperparathyroidism (HPT) over the past 30 years were retrospectively reviewed. A total of 1224 of these patients had biologically proven and cured PHPT and 211 patients had renal HPT (RHPT). The diagnosis of pancreatitis (PTS) was based on a high serum amylase level and/or abnormalities on ultrasound or computed tomography (CT) scan explorations. Only patients without biliary stones were included in the PTS group associated with HPT. RESULTS A total of 3.2% (n = 40) of patients with PHPT had PTS, which was acute in 18 cases, subacute in 8 cases and chronic in 14 cases. This rate of PTS is higher than in a random hospital population. Surgical cure of HPT was followed by the spontaneous healing of 17/18 acute PTS, whereas six of the 22 patients with subacute or chronic PTS developed complications due to the evolution of their disease (diabetes, pancreatic duct stenosis treated by surgery). A single diseased gland was found in 27 patients with PTS, which is in favour of primary parathyroid disease, being responsible for, and not a consequence of, PTS. Only the serum calcium (13.0 vs 12.1 g/dL) level was significantly increased in PHPT patients with PTS, when compared to those without PTS. The calcium level is probably of major importance in the development of PTS, which was never encountered in 211 patients with RHPT, who had low calcium and high PTH levels. CONCLUSIONS The data suggest that (i) the PTS-PHPT association is not incidental; (ii) PTS is the consequence and not the cause of PHPT; (iii) hypercalcaemia seems to be a major factor in the development of PTS in PHPT patients; and (iv) cure of PHPT leads to the healing of acute PTS, whereas it does not affect the evolution of subacute and chronic PTS.
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Affiliation(s)
- B Carnaille
- Department of General and Endocrine Surgery, University Hospital, Lille, France
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