A 65-year-old patient was hospitalized three times over a two-year period for severe acute pancreatitis. After the first hospitalization, cholecystectomy was performed. During the second hospitalization she was treated in the ICU because of the development of necrotizing emphysematous pancreatitis with the development of sepsis. During the third hospitalization the patient presents clinically with general weakness, agitation, visual hallucinations, disorientation and damaged cognitive-mnemonic functions. While being treated, elevated blood calcium levels were detected (Ca 3.35 mmol/l), and additional laboratory tests were performed (PTH 9.55 pmol/l, total Ca 2.80 mmol/l, vitamin D 8.53 mmol/l, anorganic phosphate 0.98 mmol/l). Ultrasound examination of the neck reveals a solid-cystic formation behind the left lobe of the thyroid gland. Cytological finding of the puncture formation indicates hyperplasia of the thyroid gland, and scintigraphy with Tc-99m MIBI indicates pathological accumulation of radiopharmaceuticals in the left thyroid lobe and hyper functional parathyroid gland tissue behind the left thyroid lobe. Initially she was treated with pamidronate, followed by a left thyroid lobectomy and parathyroidectomy of the left parathyroid glands. Pathohistological diagnosis indicates a parathyroid adenoma. Postoperative calcium values were normal (Ca 2.27 mmol/l) with marginally elevated TSH (TSH 5.12 mIU/l, fT4 14.03 pmol/l). Low-dose levothyroxine substitution was prescribed. Three years after the development of pancreatitis and thyroid lobectomy with parathyroidectomy, the patient was hospitalized for a new verified type 2 diabetes (FPG 19.0 mmol/l, HbA1c 13.7%) without developed micro and macrovascular complications of the disease. Insulin therapy was started, according to basal- bolus protocol (insulin aspart with human insulin) and glycaemic control was achieved.
Hypercalcemia was an etiopathogenetic basis for recurrent acute pancreatitis.
hypercalcemia, acute pancreatitis, primary hyperparathyroidism
22 May 2021 - 26 May 2021