Endocrine Abstracts

Introduction: Acute Necrotising Pancreatitis caused by Hypercalcemia secondary to Primary hyperparathyroidism is a rare condition¹. The prevalence of acute pancreatitis in patients with PHPT is estimated between 1.5% and 7%². We report a case of male patient with severe necrotising pancreatitis associated with hypercalcemia secondary to primary hyperparathyroidism.

Case Report: A 55-year-old man presented with sudden episode of severe abdominal pain to emergency department. He had a CT abdomen that showed the extensive necrotising pancreatitis. He was diagnosed with primary hyperparathyroidism 6 months ago, when he initially presented with polyuria, polydipsia, painful joints, back ache. He has no significant past medical history and not on any regular medications. He is a non-smoker and drinks alcohol socially. His blood analysis showed adjusted calcium 3.16 mmol/l, phosphate 0.79 mmol/parathormone –17.9 pmol/l, egfr-49 ml/min. He was managed conservatively with free fluids and analgesia. His stay was complicated by worsening abdominal pain and required critical care admission. His management included sliding scale insulin, patient-controlled analgesia and Naso jejunostomy feeding. His repeat imaging showed pancreatic pseudocyst for which surgical intervention was performed. Cinacalcet was commenced. Sestamibi imaging of parathyroid showed mild tracer uptake in all four parathyroid glands suggesting multi gland hyperplasia.4D CT imaging showed a nodule below the inferior pole of left lobe of thyroid gland could potentially a parathyroid adenoma. His case was discussed in Parathyroid multidisciplinary team meeting, and plan is for surgery. Interim, he had a cardiac arrest due to massive Myocardial infarction and was revived. Currently he is managing well on cinacalcet 90 mg twice daily which was gently up titrated, waiting for surgery.

Conclusion: This case illustrates primary hyperparathyroidism as one of the causes for acute necrotising pancreatitis, which can be fatal.

References: 1. World J Gastroenterol. 2010 Jun 21; 16(23): 2959–2962. 2. Rev Esp Enferm Dig. 2009;101:65–69.