Primary hyperparathyroidism presenting as acute pancreatitis: An institutional experience with review of the literature.

K G Rashmi, Sadishkumar Kamalanathan, Jayaprakash Sahoo, Dukhabandhu Naik, Pazhanivel Mohan, Biju Pottakkat, Sitanshu Sekhar Kar, Rajan Palui, Ayan Roy
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Abstract

Background: Acute pancreatitis (AP) presenting as an initial manifestation of primary hyperparathyroidism (PHPT) is uncommon, and its timely diagnosis is crucial in preventing recurrent attacks of pancreatitis.

Aim: To determine the clinical, biochemical, and radiological profile of PHPT patients presenting as AP.

Methods: This is a retrospective observational study, 51 consecutive patients admitted with the diagnosis of PHPT during January 2010 and October 2021 at a tertiary care hospital in Puducherry, India was included. The diagnosis of AP was established in the presence of at least two of the three following features: abdominal pain, levels of serum amylase or lipase greater than three times the normal, and characteristic features at abdominal imaging.

Results: Out of the 51 consecutive patients with PHPT, twelve (23.52%) had pancreatitis [5 (9.80%) AP, seven (13.72%) chronic pancreatitis (CP)]. PHPT with AP (PHPT-AP) was more common among males with the presentation at a younger age (35.20 ± 16.11 vs 49.23 ± 14.80 years, P = 0.05) and lower plasma intact parathyroid hormone (iPTH) levels [125 (80.55-178.65) vs 519.80 (149-1649.55, P = 0.01)] compared to PHPT without pancreatitis (PHPT-NP). The mean serum calcium levels were similar in both PHPT-AP and PHPT-NP groups [(11.66 ± 1.15 mg/dL) vs (12.46 ± 1.71 mg/dL), P = 0.32]. PHPT-AP also presented with more gastrointestinal symptoms like abdominal pain, nausea, and vomiting with lesser skeletal and renal manifestations as compared to patients with PHPT-NP.

Conclusion: AP can be the only presenting feature of PHPT. Normal or higher serum calcium levels during AP should always draw attention towards endocrine causes like PHPT.

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原发性甲状旁腺功能亢进表现为急性胰腺炎:一个机构的经验与文献回顾。
背景:以原发性甲状旁腺功能亢进(PHPT)为首发表现的急性胰腺炎(AP)并不常见,其及时诊断对预防胰腺炎复发至关重要。目的:确定以ap表现的PHPT患者的临床、生化和放射学特征。方法:这是一项回顾性观察性研究,纳入了2010年1月至2021年10月在印度普都切里一家三级医院连续收治的51例PHPT患者。AP的诊断建立在以下三个特征中的至少两个:腹痛,血清淀粉酶或脂肪酶水平大于正常水平的三倍,腹部影像学特征。结果:51例PHPT患者中,12例(23.52%)合并胰腺炎[5例(9.80%)为AP, 7例(13.72%)为慢性胰腺炎(CP)]。伴有胰腺炎的PHPT (PHPT-AP)更常见于年龄较小的男性(35.20±16.11岁vs 49.23±14.80岁,P = 0.05),且血浆完整甲状旁腺激素(iPTH)水平较低[125 (80.55-178.65)vs 519.80 (149-1649.55, P = 0.01)]。PHPT-AP组和PHPT-NP组的平均血钙水平相似[(11.66±1.15 mg/dL) vs(12.46±1.71 mg/dL), P = 0.32]。与PHPT-NP患者相比,PHPT-AP还表现出更多的胃肠道症状,如腹痛、恶心和呕吐,骨骼和肾脏症状较少。结论:AP可能是PHPT的唯一表现特征。AP期间正常或较高的血钙水平应引起对内分泌原因的注意,如PHPT。
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