Endocrine Abstracts (2017) 49 EP267 | DOI: 10.1530/endoabs.49.EP267

Acute pancreatitis as the first presentation of primary hyperparathyroidism

Alexandra Vieira, Marta Ferreira, Daniela Guelho, Teresa Pereira, Luis Filipe Silva, Estela Ferreira & Ana Inácio

Leiria Hospital Center, Leiria, Portugal.

Background: Hypercalcaemia due to primary hyperparathyroidism is a rare cause of acute pancreatitis, with a reported prevalence of 1.5–8%.

Clinical case: A 25-year-old male patient was referred to the Endocrinology outpatient clinic for hypercalcemia diagnosed in the context of acute pancreatitis. He had medical and surgical pathological antecedents of: clavicle fracture after car accident, cholecystectomy and appendectomy, gastroesophageal reflux disease. Current medications included proton pump inhibitor daily. Laboratory analysis reported serum calcium of 3.46 mmol/l (2.20–2.65), phosphorus of 0.70 mmol/l (0.81–1.45) and intact parathyroid hormone of 569 pg/ml (12–88). Biochemical screening for type 1 and type 2 multiple endocrine neoplasia was performed and was negative. The neck ultrasonography showed a nodular heterogeneity with hyperechogenic contours with cystic areas, and posteriorly and inferiorly to the left lobe an hypoechogenic nodular formation, with 2.4 cm of greater axis, which may correspond to the parathyroid gland with increased dimensions. Bone densitometry showed osteopenia. Sestamibi parathyroid scintigraphy revealed a focus of significant radiopharmaceutical retention on the projection of the lower left lobe pole, alteration compatible with parathyroid adenoma. A lower left parathyroidectomy and left lobectomy of thyroid was performed without complications. The histopathological result confirmed the diagnosis of parathyroid adenoma. At the last visit, he had normal PTH and calcemia values. During the follow-up he had recurrent acute pancreatites episodes.

Conclusions: The authors present this case because of its rarity: hyperparathyroidism in a young patient whose presentation was of acute pancreatitis without the classic clinic manifestations of hypercalcemia.

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