Pancreatitis and hyperparathyroidism: Still a rare association! |
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Authors: | Sandeep Thareja Manish Manrai Rajat Shukla Atul Kumar Sood Atul Jha A.K. Tyagi Vimal Upreti G.P.S. Gahlot Sachin Maggo |
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Affiliation: | 1. Consultant (Medicine) & Gastroenterologist, Base Hospital, Delhi Cantt, India;2. Associate Professor, Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India;3. Senior Advisor (Medicine & Gastroenterology), Command Hospital (Western Command), Chandigarh, India;4. Commandant, Military Hospital Dehradun, India;5. Classified Specialist (Medicine) & Gastroenterologist, Army Hospital (R&R), New Delhi, India;6. Professor & Head, Department of Surgery, Armed Forces Medical College, Pune 411040, India;7. Senior Advisor (Medicine) & Endocrinologist, 151 Base Hospital, C/o 99 APO, India;8. Classified Specialist (Pathology) & Oncopathologist, Army Hospital (R&R), New Delhi, India;9. Graded Specialist (Medicine), 2009 Field Hospital, C/o 56 APO, India |
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Abstract: | BackgroundAmong the multitudinous etiologies of pancreatitis, primary hyperparathyroidism (PHPT) is rarely associated with pancreatitis. However, the cause and effect relationship between the two still evokes controversy. We aimed to study and characterize the nature of pancreatic disease in PHPT.MethodsA retrospective single-center study was carried out in North India over a period of 1 year (June 2015 to May 2016). All patients with pancreatitis were included. In patients with high calcium levels, Intact Parathyroid Hormone (iPTH) by Radioimmunoassay (RIA) and an Technetium 99m Sestamibi scintigraphy (MIBI-Tc-99m) scan were performed.ResultsDuring the study period, 70 patients with pancreatitis were admitted to our hospital (53 with acute pancreatitis [AP] and 17 with chronic pancreatitis [CP]). Of them, 5 patients (9.4%) were detected to have PHPT. The mean age of patients was 30.4 years (20–49 years) with 3 males and 2 females, including 1 pregnant female (29th week of gestation). Contrast enhanced computed tomography (CECT) abdomen was performed in 4 cases (excluding 1 pregnant patient) with mean Computed tomography severity index (CTSI) of 4.7 (2–8). Four patients were detected to have increased uptake in one of the parathyroid glands, and the fifth patient had an ectopic parathyroid uptake in the mediastinum. All the resected samples were identified as parathyroid adenoma on histology. The patients were followed up for 1 year with no reported recurrence of symptoms.ConclusionThe data suggest an association between pancreatitis (both acute and chronic) and hypercalcemia due to PHPT. A high calcium value during AP or CP should always draw suspicion and warrants corresponding investigations in search of endocrine or malignant cause. |
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Keywords: | Acute pancreatitis Chronic pancreatitis Hypercalcemia Parathyroid adenoma Primary hyperparathyroidism |
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