Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report
Introduction. One of the more uncommon etiological factors responsible for the development of acute pancreatitis (AP) is hypercalcemia. Hyperparathyroidism (HPT), as a cause of hypercalcemia, is responsible for 1.5–13% of AP according to a number of studies. A mechanism of the development of AP in h...
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| Format: | Article |
| Language: | English |
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Military Health Department, Ministry of Defance, Serbia
2016-01-01
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| Series: | Vojnosanitetski Pregled |
| Subjects: | |
| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2016/0042-84501600121T.pdf |
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| author | Tešić-Rajković Snežana Radovanović-Dinić Biljana Mitić Branka Dinić-Radović Violeta Jovanović Maja |
| author_facet | Tešić-Rajković Snežana Radovanović-Dinić Biljana Mitić Branka Dinić-Radović Violeta Jovanović Maja |
| author_sort | Tešić-Rajković Snežana |
| collection | DOAJ |
| description | Introduction. One of the more uncommon etiological factors responsible for the development of acute pancreatitis (AP) is hypercalcemia. Hyperparathyroidism (HPT), as a cause of hypercalcemia, is responsible for 1.5–13% of AP according to a number of studies. A mechanism of the development of AP in hyperparathyroidism is still unclear. Case report. We presented a 47-year-old female patient, who had five episodes of AP in total before the etiological factors were finally determined. The patient had certain comorbidities which were considered to be potential causes of AP. She had chronic renal insufficiency (she was on a regular hemodialysis program), systemic lupus erythematosus and mioma uteri. She used to regularly take an antiepileptic drug (combination of sodium valproate and valproic acid). During the fifth episode of AP, the serum calcium level was for the first time elevated to twice the normal value. Level of parathyroid hormone was several times higher. A static scintigraphy found hyperplasia or hyperfunctional adenoma of the right inferior and superior parathyroid glands. Abdominal multislice computed tomography (MSCT) scan verified the enlargement of the entire pancreas, as well as the presence of heterogeneous structures with diffuse amorphous calcifications. The lytic lesions in the pelvic bones could be seen in both sides. Parathyroidectomy was being postponed by an endocrine surgeon because of the poor overall condition of the patient. In the next period the patient had five more episodes of AP. The condition was significantly contributed by increasingly more frequent and longer episodes of metrorrhagia. Despite all therapeutic measures that were taken, systemic inflammatory response syndrome (SIRS) developed, and fatal outcome occurred. Conclusion. In case of recurrent pancreatitis, hyperparathyroidism is to be considered even if a significant elevation of serum calcium is not present. This is especially the case for patients with chronic renal insufficiency or impaired vitamin D metabolism, who have a higher risk of secondary hyperthyroidism. |
| first_indexed | 2024-12-21T21:22:20Z |
| format | Article |
| id | doaj.art-3ee254c53be745c190d12114efca3f22 |
| institution | Directory Open Access Journal |
| issn | 0042-8450 2406-0720 |
| language | English |
| last_indexed | 2024-12-21T21:22:20Z |
| publishDate | 2016-01-01 |
| publisher | Military Health Department, Ministry of Defance, Serbia |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj.art-3ee254c53be745c190d12114efca3f222022-12-21T18:49:51ZengMilitary Health Department, Ministry of Defance, SerbiaVojnosanitetski Pregled0042-84502406-07202016-01-0173111064106710.2298/VSP150210121T0042-84501600121THyperparathyroidism as a cause of recurrent acute pancreatitis: A case reportTešić-Rajković Snežana0Radovanović-Dinić Biljana1Mitić Branka2Dinić-Radović Violeta3Jovanović Maja4Clinical Center Niš, Clinic for Gastroenterology and Hepatology, NišClinical Center Niš, Clinic for Gastroenterology and Hepatology, Niš + Faculty of Medicine, NišFaculty of Medicine, Niš + Clinical Center Niš, Institute of Nephrology and Hemodialysis, NišClinical Center Niš, Clinic for Gastroenterology and Hepatology, NišFaculty of Medicine, Niš + Clinical Center Niš, Clinic for Infectious Diseases, NišIntroduction. One of the more uncommon etiological factors responsible for the development of acute pancreatitis (AP) is hypercalcemia. Hyperparathyroidism (HPT), as a cause of hypercalcemia, is responsible for 1.5–13% of AP according to a number of studies. A mechanism of the development of AP in hyperparathyroidism is still unclear. Case report. We presented a 47-year-old female patient, who had five episodes of AP in total before the etiological factors were finally determined. The patient had certain comorbidities which were considered to be potential causes of AP. She had chronic renal insufficiency (she was on a regular hemodialysis program), systemic lupus erythematosus and mioma uteri. She used to regularly take an antiepileptic drug (combination of sodium valproate and valproic acid). During the fifth episode of AP, the serum calcium level was for the first time elevated to twice the normal value. Level of parathyroid hormone was several times higher. A static scintigraphy found hyperplasia or hyperfunctional adenoma of the right inferior and superior parathyroid glands. Abdominal multislice computed tomography (MSCT) scan verified the enlargement of the entire pancreas, as well as the presence of heterogeneous structures with diffuse amorphous calcifications. The lytic lesions in the pelvic bones could be seen in both sides. Parathyroidectomy was being postponed by an endocrine surgeon because of the poor overall condition of the patient. In the next period the patient had five more episodes of AP. The condition was significantly contributed by increasingly more frequent and longer episodes of metrorrhagia. Despite all therapeutic measures that were taken, systemic inflammatory response syndrome (SIRS) developed, and fatal outcome occurred. Conclusion. In case of recurrent pancreatitis, hyperparathyroidism is to be considered even if a significant elevation of serum calcium is not present. This is especially the case for patients with chronic renal insufficiency or impaired vitamin D metabolism, who have a higher risk of secondary hyperthyroidism.http://www.doiserbia.nb.rs/img/doi/0042-8450/2016/0042-84501600121T.pdfpancreatitishyperparathyroidismcomorbiditydiagnosis, differentialkidney failure, chronic |
| spellingShingle | Tešić-Rajković Snežana Radovanović-Dinić Biljana Mitić Branka Dinić-Radović Violeta Jovanović Maja Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report Vojnosanitetski Pregled pancreatitis hyperparathyroidism comorbidity diagnosis, differential kidney failure, chronic |
| title | Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report |
| title_full | Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report |
| title_fullStr | Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report |
| title_full_unstemmed | Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report |
| title_short | Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report |
| title_sort | hyperparathyroidism as a cause of recurrent acute pancreatitis a case report |
| topic | pancreatitis hyperparathyroidism comorbidity diagnosis, differential kidney failure, chronic |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2016/0042-84501600121T.pdf |
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