Endocrine Abstracts

Introduction: Pancreatitis due to hypercalcemia from primary hyperparathyroidism is rare with an incidence of 1–1.5%. We report on a case of recurrent pancreatitis secondary to an ectopic parathyroid adenoma with co-existing severe vitamin D deficiency with its management difficulties.

Case report: A 45-year-old male admitted to the hospital with abdominal pain and attendant nausea had investigations ruling out structural lesions for his symptoms but ultrasound evidence of acute pancreatitis. He was noted to have severe hypercalcemia with raised amylase. He was managed conservatively and further evaluation revealed elevated parathormone levels. An ultrasound of his parathyroid failed to localize any adenoma while the sestamibi scan showed activity in the right para sternocleidomastoid region consistent with an ectopic parathyroid tissue. He has had two further admissions with acute pancreatitis secondary to hypercalcemia. Co-existing severe vitamin D deficiency was discovered which required correction to optimize his chances of a successful outcome post-surgery. This case was challenging because of its rarity. Vitamin D deficiency correction attempts frequently led to severe hypercalcemia which in itself posed additional risk of recurrent pancreatitis. The patient was referred for urgent consideration of surgery for removal of his ectopic parathyroid.

Conclusion: Primary hyperparathyroidism may rarely provoke acute pancreatitis but for recurrent pancreatitis to occur is indeed very unusual save for hereditary primary hyperparathyroidism. Our patient in question had an ectopic parathyroid which was revealed by adopting a more intensive investigation approach following initial negative ultrasound. Correcting severe vitamin D deficiency with careful management of severe hypercalcemia presents its own treatment challenges especially with stone formation in the urinary tract but recurrent pancreatitis triggered by hypercalcemia presents a management nightmare which involves close monitoring of numbers as a prelude to ensuring an optimal outcome following surgery.