Endocrine Abstracts

Acute pancreatitis is a common etiology of acute abdominal pain, it has multiple causes including hypercalcemia. It is a rare manifestation of primary hyperparathyroidism, reported only in 3-15% of cases which can lead to a diagnostic and therapeutic delay. This is a case of a 76-year-old patient who presented with acute CTSI-3 pancreatitis and severe hypercalcemia at 153.09 mg/l (3.82 mmol/l). Despite the regression of the signs of pancreatitis with treatment, his general condition remained altered with signs of dehydration and diffuse bone pain. The patient developed a second episode of acute pancreatitis 2 months later. The malignant origin was suspected following resistant hypercalcemia and the presence of vertebral nodular images on MRI. However, this hypothesis was ruled out after multiple investigations in favor of primary hyperparathyroidism with degenerative bone lesions. The PTH was high at 758, 8 pg/ml, cervical ultrasound showed a right cervical image with parathyroid scintigraphy confirming the diagosis of right parathyroid nodule. The patient underwent an adenomectomy inducing a peroperative reduction in the PTH level to 92.7pg/ml after thirty minutes. The histological study found a 33mm encapsulated parathyroid adenoma with principal cells, and a KI67 estimated at 2%. Postoperatively, we noted a return to normal of serum calcium and PTH as well as a good clinical evolution of the general condition and disappearance of the pain. The control CT was without abnormalities apart from a few non-infected peripancreatic collections. Furthermore, we did not find any lesions suggestive of MEN or other cases in the patient’s family. In case of acute pancreatitis without a history of cholelithiasis or alcoholism, rare causes, particularly hyperparathyroidism, must be sought. Early diagnosis and adenomectomy allow definitive managment and prevent recurrence of acute pancreatitis.