Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PPH) may be complicated by pancreatitis. The association of primary hyperparathyroidism with pancreatitis is rare, We report the case of three patients presenting with hyperparathyroidism revealed by acute pancreatitis.

Observation: A 78-year-old female patient with no previous history of pancreatitis presented to the emergency department with abdominal pain and bilious vomiting. An abdominal CT scan was ordered, revealing pancreatitis stage C. A etiological investigation revealed a profile of primary hyperparathyroidism with PTH at 397 pg/ml, hypercalcemia at 147 mg/l and hypophosphatemia at 19 mg/l. Patient aged 60, with no particular history, admitted for management of primary hyperparathyroidism, during his hospitalization he presented with epigastric pain associated with vomiting, a workup was ordered in favor of very high lipasemia and an abdominal CT scan was also ordered in favor of stage A pancreatitis. A 56-year-old patient with chronic kidney disease presented with an acute digestive complaint of abdominal pain and vomiting, associated with diffuse bone pain. A workup was ordered, and found to be consistent with primary hyperparathyroidism. Localization workup confirmed parathyroid localization in our 3 patients, and parathyroidectomy was performed with good evolution.

Discussion/conclusion: The association between HPTP and pancreatitis is rare, however, the pathophysiology of this association is still poorly understood. The relationship between HPTP1 and pancreatitis is controversial to date, although most publications and experimental data in favor of a direct or indirect causal role for hypercalcemia via activation of pancreatic proteases. The degree of hypercalcemia may play an important role in this association. Calcium levels should be measured in all patients with acute pancreatitis.