Parathyroid Adenoma and Hypercalcemic Crisis; a Rare Cause of Acute Pancreatitis

The relationship between primary hyperparathyroidism and pancreatitis has yet to be established firmly. We present a patient with acute pancreatitis and a hypercalcemic crisis induced by a parathyroid adenoma. A 72-year-old woman presented with lethargy and a constant pain in the epigastric region. She had a medical history of diabetes mellitus, hypertension, nephrolithiasis, and ischemic heart disease. Blood examination revealed leukocytosis and high serum amylase and lipase levels. Ultrasound exam confirmed the diagnosis of acute pancreatitis with a normal biliary tract and no gallstones. On further evaluation severe hypercalcemia (24 mg/dL) was detected, which was treated with 0.9% sodium chloride solution and calcitonin. The acute pancreatitis and its symptoms resolved after 3 days. Ultrasound exam and technetium 99 m sestamibi scan showed a parathyroid lesion. Ultimately the patient underwent right thyroid lobectomy because of refractory hypercalcemia. The pathology report was indicative of a parathyroid adenoma. Subsequently, the parathyroid gland was resected with normalization of calcium, parathyroid hormone, and amylase levels and the patient was discharged in good condition 7 days after surgery. Apart from the acute supportive management, common to all cases of acute pancreatitis, definite management must be tailored to the specific cause. Hypercalcemia during the course of pancreatitis must prompt an investigation for primary hyperparathyroidism with early surgical intervention if a parathyroid source is detected.