Endocrine Abstracts

We present a case report of a young female patient with hypercalcemia-induced acute necrotizing pancreatitis as first manifestation of a benign parathyroid adenoma.

Case: A 46-year-old female presented at the emergency room with a sudden attack of severe epigastric pain and vomiting. Clinical examination revealed a severely ill patient, a silent abdomen which was distended with painful percussion and palpation of the epigastrium. Blood analysis showed signs of inflammation. Serum amylase was 754 U/l (24–72 U/l) and serum lipase was 7189 U/l (13–300 U/l). Serum calcium was increased to 13.3 mg/dl. Based on the clinical picture and blood analysis she was diagnosed with acute pancreatitis. Abdominal ultrasound was carried out and showed no evidence of cholelithiasis or dilated bile ducts. Abdominal CT scan showed the development of pancreatic pseudocysts and necrosis of the pancreas with few remnants of normal pancreatic tissue. The patient was treated conservatively with intravenous fluids and analgesia. After that broad spectrum antibiotics was started because of recurrent episodes of fever and abdominal pain. Serum levels of intact parathyroid hormone (iPTH) were determined and showed an increase up to 273 pg/ml (13–54 pg/ml). This result confirmed hypercalcemia caused by hyperparathyroidism. Ultrasound of the parathyroid glands showed tumor adjacent to the left thyroid lobe. The patient underwent surgical resection of this tumor, and histological examination confirmed the diagnosis of benign parathyroid adenoma. After that surgical cystogastrostomy and necrosectomy of the pancreatic corpus was performed. She recovered well and the patient remained free of symptoms without signs of exocrine or endocrine pancreas insufficiency.

Result: Good cooperation between gastroenterologists, endocrinologists and surgeons is important in treating this rare phenomenon of acute necrotizing pancreatitis caused by PHPT induced hypercalcemia.