SAT243 A Rare Triad

Abstract

Abstract Disclosure: H. Liaqat: None. F. Pasha: None. L. Chavez: None. Introduction: Hypercalcemia contributing to and directly causing pancreatitis is a well-known etiology in literature. Possible mechanisms identified include increased intrapancreatic conversion from trypsinogen to trypsin leading to damage of the pancreas and deposition of calcium in the pancreatic duct followed by pancreatic duct obstruction. The etiology of hypercalcemia-induced acute pancreatitis is usually hypercalcemia of malignancy. Less than ten cases of sarcoid-induced hypercalcemia leading to acute pancreatitis have been reported in the literature. Case Report: We present a case of a 39-year-old male who presented with complaints of generalized fatigue 60, pound weight loss, severe abdominal pain and sensation of lumps in his groin and neck. Examination revealed cervical and inguinal lymphadenopathy and a palpable spleen. Blood work revealed elevated lipase, creatinine, and hypercalcemia up to 14.8 mg/dl. Initial imaging revealed massive hepatosplenomegaly, hilar adenopathy and bilaterally miliary nodules in the lungs. Further workup of hypercalcemia revealed suppressed PTH, normal levels of PTHrP, and 25 hydroxyvitamin but elevated ACE levels and 1,25 dihydroxy vitamin D. Presentation and workup was concerning for sarcoidosis, and diagnosis was confirmed with a liver biopsy. The patient was treated initially with IV fluids, calcitonin, and steroids with resolution of his hypercalcemia and eventually pancreatitis symptoms. Case Discussion: Less than ten cases of sarcoid-induced hypercalcemia leading to acute pancreatitis have been reported in the literature, making this an extremely rare triad. The mechanism remains similar to other causes of hypercalcemia that lead to pancreatitis. Despite steroids not being recommended during an acute pancreatitis episode, this is one of the uncommon instances where steroids would be the preferred approach to tackle sarcoid-induced hypercalcemia. Other calcium-lowering therapies can be used short term like calcitonin and zoledronic acid. Presentation: Saturday, June 17, 2023