Primary hyperparathyroidism and pancreatitis
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ORIGINAL ARTICLE
Primary hyperparathyroidism and pancreatitis R. A. Misgar1 · M. H. Bhat1 · T. A. Rather2 · S. R. Masoodi1 · A. I. Wani1 · M. I. Bashir1 · M. A. Wani3 · A. A. Malik3 Received: 17 December 2019 / Accepted: 18 March 2020 © Italian Society of Endocrinology (SIE) 2020
Abstract Purpose The true association between primary hyperparathyroidism (PHPT) and pancreatitis continues to be controversial. In this study, we present clinical data, investigative profile, management and follow-up of PHPT patients with pancreatitis and compare this group with PHPT patients without pancreatitis. Methods Records of 242 patients with PHPT managed at our center over 24 years were retrospectively analyzed for demographic and laboratory data. The diagnosis of pancreatitis was entertained in the presence of at least two of the three following features: abdominal pain, levels of serum amylase greater than three times the normal or characteristic features at imaging. Results Fifteen (6.19%) of the 242 consecutive patients with PHPT had had pancreatitis. Fourteen patients (93.3%) had acute pancreatitis (AP), while one patient had chronic calcific pancreatitis. Over half (8 of 14) of the patients with AP had at least two episodes of pancreatitis. Pancreatitis was the presenting symptom in 14 (93.3%) patients. None of the pancreatitis cases had additional risk factors for pancreatitis. PHPT patients with pancreatitis had significantly higher serum calcium and ALP than PHPT patients without pancreatitis. After successful parathyroidectomy, 14 patients had no further attacks of pancreatitis during a median follow-up of 16 months (range 2–41 months), while recurrence of pancreatitis was seen in one patient. Conclusions We conclude that pancreatitis can be the only presenting complaint of PHPT. Our study highlights the importance of fully investigating for PHPT in any pancreatitis patient with high normal or raised serum calcium level, especially in the absence of other common causes of pancreatitis. Keywords Primary hyperparathyroidism · Pancreatitis · Hypercalcemia
Introduction Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder in the West after diabetes mellitus and thyroid disorders [1]. One percent of all adults and 2% of people aged over 55 years in the West have PHPT [2]. PHPT has scaled down into an asymptomatic disease in much of the western world. However, in developing countries like India, it continues to be, for the most part, a symptomatic
* R. A. Misgar [email protected] 1
Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
2
Department of Nuclear Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
3
Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
disease with skeletal, renal, cardiovascular, neuropsychiatric, and gastrointestinal manifestations [3–5]. PHPT has been linked with both acute and chronic pancreatitis since the
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