858 Parathyroid Adenoma Manifesting as Acute Pancreatitis: A Case Report and Literature Review. (19th August 2022)

• Record Type: Journal Article
• Authors: Ayathamattam, J; Rotherham, M; Bosman, D
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 6
• Publication Date: 2022-08-19
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac269.223
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: Pancreatitis is commonplace on the acute surgical take. It is usually caused by gallstones or alcohol excess. Parathyroid adenoma causing hypercalcaemia is a rare cause of pancreatitis. Case report: Here we describe a case of a 45-year-old gentleman with no past medical history who presented with epigastric pain and vomiting. A CT scan revealed acute pancreatitis. After a normal biliary tree ultrasound scan, the cause was initially proposed to be alcohol although he reported an average intake of only 4–6 units/day. However, on closer inspection of blood tests, it was apparent that he had a severe hypercalcaemia at 3.45mmol/L and a hypophosphataemia. This raised the suspicion of a primary hyperparathyroidism. Accordingly, a parathyroid hormone level was measured and shown to be 90pmol/L! An ultrasound scan of the neck confirmed the underlying cause to be a parathyroid adenoma. Due to the severity of electrolyte imbalances, this adenoma was excised during the same admission. The patient's symptoms resolved, and he was discharged with planned follow up after genetic testing for multiple endocrine neoplasia syndromes. Literature review: There have been many similar cases reported in the last 10 years but primary hyperparathyroidism causing pancreatitis remains rare. Multiple cases involved recurrent acute pancreatitis before parathyroid lesions were diagnosed. Conclusion: This case highlights the importance of investigating other causes of pancreatitis where gallstones and alcohol excess have been ruled out. Furthermore, it is pertinent for surgical trainees, who usually check blood tests initially, to be able to interpret electrolyte imbalances in the context of surgical disease.