Parathyroid Adenoma Presenting as Acute Pancreatitis

Abstract

Aim: To discuss an unusual presentation of parathyroid adenoma with management. Background: Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia with elevated levels of parathyroid hormone (PTH). Parathyroid adenoma is the underlying cause in 85% of patients with PHPT. Case description: A 49-year-old woman presented with acute abdominal pain and was diagnosed to have acute pancreatitis. Routine investigations revealed hypercalcemia (serum calcium > 14 mg/dL) and elevated PTH (1,440 pg/mL). Initial ultrasound imaging of the neck showed an ill-defined hypoechoic space-occupying lesion with a cystic component in the lower pole of the right lobe of the thyroid gland. This was followed by a Sestamibi scan and SPECT CT. The patient underwent surgery after proper preoperative preparation. The level of PTH was reduced to 293 pg/mL on the first postoperative day. Serum calcium measured remained within normal limits. Conclusion: Pancreatitis is a rare presentation of parathyroid adenoma, but the diagnosis must be kept in mind while treating patients. Clinical significance: Patients with recurrent unexplainable pancreatitis should be worked up for parathyroid adenoma.