Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Jul 5, 2022; 13(4): 47-56
Published online Jul 5, 2022. doi: 10.4292/wjgpt.v13.i4.47
Primary hyperparathyroidism presenting as acute pancreatitis: An institutional experience with review of the literature
K G Rashmi, Sadishkumar Kamalanathan, Jayaprakash Sahoo, Dukhabandhu Naik, Pazhanivel Mohan, Biju Pottakkat, Sitanshu Sekhar Kar, Rajan Palui, Ayan Roy
K G Rashmi, Sadishkumar Kamalanathan, Jayaprakash Sahoo, Dukhabandhu Naik, Rajan Palui, Ayan Roy, Department of Endocrinology, JIPMER, Puducherry 605006, India
Pazhanivel Mohan, Department of Medical Gastroenterology, JIPMER, Puducherry 605006, India
Biju Pottakkat, Department of Surgical Gastroenterology, JIPMER, Puducherry 605006, India
Sitanshu Sekhar Kar, Department of Preventive and Social Medicine, JIPMER, Puducherry 605006, India
Author contributions: Rashmi KG, Palui R and Roy A acquisition of the data and the drafting of the work; Sahoo J, Kamalanathan S and Naik D conceptualized the work, supervised the writing, gave intellectual inputs, and critically revised the manuscript; Mohan P and Pottakkat B designed the work, gave intellectual inputs and critically revised the manuscript; Kar SS interpreted the data and gave intellectual inputs; all of them approved the final version of the manuscript to be published.
Institutional review board statement: The study was reviewed and approved by the Institutional Ethics Committee for observational studies of JIPMER, Puducherry, India.
Informed consent statement: The waiver of consent was granted by the Institutional Ethics Committee for observational studies of JIPMER, Puducherry, India.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Data sharing statement: Data will be provided on request.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jayaprakash Sahoo, MD, DM, Additional Professor, Endocrinology, JIPMER, Room 5444, Fourth Floor, Superspecialty Block, Puducherry 605006, India. jppgi@yahoo.com
Received: January 3, 2022
Peer-review started: January 3, 2022
First decision: March 10, 2022
Revised: March 24, 2022
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: July 5, 2022
Abstract
BACKGROUND

Acute pancreatitis (AP) presenting as an initial manifestation of primary hyperparathyroidism (PHPT) is uncommon, and its timely diagnosis is crucial in preventing recurrent attacks of pancreatitis.

AIM

To determine the clinical, biochemical, and radiological profile of PHPT patients presenting as AP.

METHODS

This is a retrospective observational study, 51 consecutive patients admitted with the diagnosis of PHPT during January 2010 and October 2021 at a tertiary care hospital in Puducherry, India was included. The diagnosis of AP was established in the presence of at least two of the three following features: abdominal pain, levels of serum amylase or lipase greater than three times the normal, and characteristic features at abdominal imaging.

RESULTS

Out of the 51 consecutive patients with PHPT, twelve (23.52%) had pancreatitis [5 (9.80%) AP, seven (13.72%) chronic pancreatitis (CP)]. PHPT with AP (PHPT-AP) was more common among males with the presentation at a younger age (35.20 ± 16.11 vs 49.23 ± 14.80 years, P = 0.05) and lower plasma intact parathyroid hormone (iPTH) levels [125 (80.55-178.65) vs 519.80 (149-1649.55, P = 0.01)] compared to PHPT without pancreatitis (PHPT-NP). The mean serum calcium levels were similar in both PHPT-AP and PHPT-NP groups [(11.66 ± 1.15 mg/dL) vs (12.46 ± 1.71 mg/dL), P = 0.32]. PHPT-AP also presented with more gastrointestinal symptoms like abdominal pain, nausea, and vomiting with lesser skeletal and renal manifestations as compared to patients with PHPT-NP.

CONCLUSION

AP can be the only presenting feature of PHPT. Normal or higher serum calcium levels during AP should always draw attention towards endocrine causes like PHPT.

Keywords: Acute pancreatitis, Chronic pancreatitis, Parathyroid hormone, Primary hyperparathyroidism, Skeletal manifestations

Core Tip: Acute pancreatitis (AP) is a rare complication of primary hyperparathyroidism (PHPT) and can be its only presenting symptom. In this study, we retrospectively analyzed our single-center data of 51 PHPT patients between 2010 and 2021. The study showed that 9.8% of PHPT patients presented with AP. Patients with PHPT with AP patients presented at a younger age with a male preponderance and a lower frequency of skeletal and renal involvement as compared to patients with PHPT without pancreatitis. Early diagnosis and surgery for PHPT in AP will prevent recurrent attacks of AP and other PHPT-related complications.