Pancreatitis-Primary Hyperparathyroidism Association: Case Report and Literature Review

The relationship of cause and effect between acute pancreatitis and primary hyperparathyroidism (pHPT) continues to be debated. Critics see any association of pancreatitis with pHPT as only incidental or even a result of parathyroid surgery. Counter arguments claim that pancreatitis is actually a manifestation of pHPT and definitive management of such pancreatitis should be directed towards dealing with the hyperparathyroidism. Our paper aims to review the debate in the published medical literature starting from the first reporting of such association in 1947. In this controversy we add our own case of a 49-year old non-alcoholic man presenting with recurrent attacks of acute pancreatitis. Investigated with ultrasound, CT scan, ERCP and biochemical profiles, it was not until his 3^rd admission that his raised serum calcium was acted upon. High intact parathyroid levels were confirmed. Open neck exploration found a solitary parathyroid adenoma. After surgery the serum calcium returned to normal and abdominal symptoms have not recurred in the subsequent three years. This supports our belief that acute pancreatitis is one of the symptoms of pHPT, often caused by a parathyroid adenoma and curable by its excision. Calcium and parathyroid profiles should be scrutinized in all fresh cases of acute pancreatitis.