Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PPH) can be complicated by pancreatitis. The frequency of association of primary hyperparathyroidism with pancreatitis is rare, varying between 1.5% and 7%. We report the case of a patient with hyperparathyroidism revealed by acute pancreatitis.

Case: A 78-year-old patient, without any particular history, who consulted the emergency room for an acute digestive picture with abdominal pain and bilious vomiting, an abdominal CT scan was ordered showing stage D pancreatitis. After eliminating other classical causes of pancreatitis with a normal triglyceride level. The etiological research revealed a profile of primary hyperparathyroidism: PTH: 392 pg/ml or 9×normal, hypercalcemia: 141 mg/l (85–105), hypophosphatemia 19 mg/l (20–45). Cervical ultrasound and cervico-thoracic MRI confirmed the parathyroid localization by showing a paratrachial formation dte in front of the post edge of the inf pole of the thyroid lobe dte measuring 17×15×23 mm. The workup for hypercalcemia was unremarkable. The patient was rehydrated and given furosemide, and when her blood calcium level did not improve, she was given a bisphosphonate infusion. After the normalization of the calcemia the patient underwent a parathyroidectomy with good clinical and biological evolution.

Discussion and conclusion: The association between HPTP and pancreatitis is rare, however, the pathophysiology of this association is still unknown. Experimental data support a direct or indirect role of hypercalcemia via activation of pancreatic proteases. Acute pancreatitis may be indicative of HPTP, which should be systematically investigated in all acute pancreatitis, in the absence of an obvious cause.