Recurrent acute pancreatitis and primary hyperparathyroidism in patients presenting to the emergency department: Diagnostic challenges

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.

Keywords: Pancreatitis; Recurrent pancreatitis; Primary hyperparathyroidism; Hypercalcemia; Emergency medicine; Pediatric pancreatitis; Parathyroid adenoma; Abdominal pain; Multidisciplinary approach; Imaging techniques

Core Tip: Recurrent cases of acute pancreatitis can present a diagnostic challenge in the emergency department and are rarely caused by underlying endocrine disorders such as primary hyperparathyroidism (PHPT). PHPT can lead to hypercalcemia, increasing the risk of pancreatitis, which may present with less pronounced symptoms, especially in children. Emergency medicine clinicians should adopt a careful clinical assessment and multidisciplinary approach to differentiate rare etiologies, especially in cases of atypical pancreatitis. This case highlights that PHPT may be missed in pediatrics and suggests using high clinical suspicion and advanced imaging techniques to make the correct diagnosis.