Citation Information :
Kotwal N, Bansal N. Pancreatitis due to Primary Hyperparathyroidism: A Case Series and Review of Literature. World J Endoc Surg 2022; 14 (3):87-91.
Introduction: Here we describe six cases of primary hyperparathyroidism presenting initially as acute pancreatitis. Further evaluation of our cases not only confirmed primary hyperparathyroidism on the biochemical investigation but also localized the parathyroid adenoma by nuclear imaging.
Discussion: A thorough literature search confirmed that pancreatitis is a rare initial manifestation of primary hyperparathyroidism. We also tried to compare previously published case series of pancreatitis and primary hyperparathyroidism both in India and across the world. Young age, male sex, and presence of normocalcemia or hypercalcemia at diagnosis of pancreatitis need to be further evaluated for primary hyperparathyroidism after initial acute management of pancreatitis.
Conclusion: Though hypercalcemia due to primary hyperparathyroidism is mainly responsible for the development of pancreatitis, the role of other genetic and environmental influences also exists as per multihit hypothesis to manifest as pancreatitis in addition to the main role of hypercalcemia.
Jha S, Jayaraman M, Jha A, et al. Primary hyperparathyroidism: a changing scenario in India. Indian J Endocrinol Metab 2016;20(1):80–83. DOI: 10.4103/2230-8210.172237
Carnaille B, Oudar C, Pattou F, et al. Pancreatitis and primary hyperparathyroidism: forty cases. Aust N Z J Surg 1998;68(2):117–119. DOI: 10.1111/j.1445-2197.1998.tb04719.x
Chowdhury SD, Kurien RT, Pal S, et al. Acute pancreatitis and hyperparathyroidism: a case series. Indian J Gastroenterol 2014;33(2):175–177. DOI: 10.1007/s12664-013-0430-2
Gupta AK, Madnani M, Mistry J, et al. Primary hyperparathyroidism with pancreatitis: experience of management in 5 patients with review of literature. Indian J Gastroenterol 2014;33(5):484–486. DOI: 10.1007/s12664-014-0470-2
Thareja S, Manrai M, Shukla R, et al. Pancreatitis and hyperparathyroidism: still a rare association! Med J Armed Forces India 2019;75(4):444–449. DOI: 10.1016/j.mjafi.2018.11.004
Shah VN, Bhadada SK, Bhansali A, et al. Influence of age and gender on presentation of symptomatic primary hyperparathyroidism. J Postgrad Med 2012;58(2):107–111. DOI: 10.4103/0022-3859.97171
Mixter CG Jr, Keynes WM, Cope O. Further experience with pancreatitis as a diagnostic clue to hyperparathyroidism. N Eng J Med 1962;266:265. DOI: 10.1056/NEJM196202082660601
Bess MA, Edis AJ, van Heerden JA. Hyperparathyroidism and pancreatitis. Chance or a causal association? JAMA 1980;243(3): 246–247. DOI: 10.1001/jama.1980.03300290028015
Agarwal A, George RK, Gupta SK, et al. Pancreatitis in patients with primary hyperparathyroidism. Indian J Gastroenterol 2003;22(6): 224–225. PMID: 15030035.
Bhadada SK, Udawat HP, Bhansali A, et al. Chronic pancreatitis in primary hyperparathyroidism: comparison with alcoholic and idiopathic chronic pancreatitis. J Gastroenterol Hepatol 2008;23(6):959–964. DOI: 10.1111/j.1440-1746.2007.05050.x
Jacob JJ, John M, Thomas N, et al. Does hyperparathyroidism cause pancreatitis? A South Indian experience and a review of published work. ANZ J Surg 2006;76(8):740–744. DOI: 10.1111/j.1445-2197.2006.03845.x
Alle JL, Kinnaert P, Van Geertruyden J. Surveillance post-opératoire des malades opérés pour hyperparathyroïdie primaire. Ann Chir (Paris) 1984;38(5):325–334.
Ito Y, Iwase H, Tanaka H, et al. Metachronous primary hyperparathyroidism due to a parathyroid adenoma and a subsequent carcinoma: report of a case. Surg Today 2001;31(10):895–898. DOI: 10.1007/s005950170030
Giusti F, Tonelli F, Brandi ML. Primary hyperparathyroidism in multiple endocrine neoplasia type 1: when to perform surgery? Clinics (Sao Paulo) 2012;67(Suppl 1):141–144. DOI: 10.6061/clinics/2012(sup01)23
Khoo TK, Vege SS, Abu-Lebdeh HS, et al. Acute pancreatitis in primary hyperparathyroidism: a population-based study. J Clin Endocrinol Metab 2009;94(6):2115–2118. DOI: 10.1210/jc.2008-1965
Bai HX, Giefer M, Patel M, et al. The association of primary hyperparathyroidism with pancreatitis. J Clin Gastroenterol 2012;46(8):656–661. DOI: 10.1097/MCG.0b013e31825c446c
Cope O, Culver PJ, Mixter CG Jr, et al. Pancreatitis, a diagnostic clue to hyperparathyroidism. Ann Surg 1957;145(6):857–863. DOI: 10.1097/00000658-195706000-00007
Frick T, Fernandez-del-Castillo C, Bimmler D, et al. Elevated calcium and activation of trypsinogen in rat pancreatic acini. Gut 1997;41(3):339–343. DOI: 10.1136/gut.41.3.339
Felderbauer P, Karakas E, Fendrich V, et al. Pancreatitis risk in primary hyperparathyroidism: relation to mutations in the SPINK1 trypsin inhibitor (N34S) and the cystic fibrosis gene. Am J Gastroenterol 2008;103(2):368–374. DOI: 10.1111/j.1572-0241.2007.01695.x
Felderbauer P, Karakas E, Fendrich V, et al. Multifactorial genesis of pancreatitis in primary hyperparathyroidism: evidence for “protective” (PRSS2) and “destructive” (CTRC) genetic factors. Exp Clin Endocrinol Diabetes 2011;119(1):26–29. DOI: 10.1055/s-0030-1255106