Acute Pancreatitis in a Patient With Parathyroid Carcinoma: A Case Report

Abstract

Parathyroid carcinoma is a rare endocrine malignancy. Clinical features of parathyroid carcinoma are mainly due to the effects of primary hyperparathyroidism (PHPT). Hypercalcemia produced by primary or secondary hyperparathyroidism is a rare and unclear cause of acute pancreatitis. Acute pancreatitis was rarely described before as the first manifestation of parathyroid carcinoma. The case concerns a 45-year-old man with hypercalcemia (15.9 mg/dL) and high levels of parathyroid hormone (1,089 pg/mL). Laboratory findings and ultrasound directed to right nodular goitre and an adenoma of the right lower parathyroid. The patient underwent right parathyroidectomy and ipsilateral loboistmectomy with laterocervical lymphadenectomy. On the first postoperative day he reported pain in the epigastrium, resistant to analgesics. Laboratory values and computed tomography (CT) scan, associated with clinical data, indicated exudative pancreatitis. It was treated with medical therapy; after some days there was resolution of symptoms and laboratory indexes returned to normal value. Histological examination diagnosed infiltrating parathyroid carcinoma that exceeded its capsule and infiltrated fibroadipose, muscular and perithyroidal tissues. After 18 months, no signs of local recurrence or metastases were observed. Our case report is unusual for its presentation. Acute pancreatitis can be observed in patient with PHPT, but it rarely reveals after parathyroidectomy. In patient who underwent parathyroidectomy with previous hypercalcemia associated with abdominal pain, acute pancreatitis should be suspected. J Endocrinol Metab. 2020;10(2):54-56 doi: https://doi.org/10.14740/jem636