Rare case of pancreatitis treated by minimally invasive parathyroidectomy

Abstract

Hypercalcaemia-induced pancreatitis is a rare and often overlooked phenomena. Despite hyperparathyroidism being a common cause of hypercalcaemia, the association between pancreatitis and hyperparathyroidism remains controversial and is often overlooked. Patients may however suffer serious complications when diagnosis and treatment of hyperparathyroidism are delayed due to insufficient awareness. We present a man in his 40s who was admitted with progressive epigastric pain due to pancreatitis. Blood tests showed elevated serum calcium levels, which led to extensive investigation. Further workups led to the diagnosis of primary hyperparathyroidism due to three parathyroid adenomas. The patient underwent minimally invasive parathyroidectomy, which was followed by an uncomplicated recovery and normal serum calcium levels.

Keywords: Calcium and bone; Head and neck surgery; Thyroid disease.

Figure 1

CT of the abdomen showing an acute pancreatitis with diffuse parenchymal enlargement, indistinct pancreatic margins and focal necrosis.

Figure 2

Scintigraphy showing two possible parathyroid adenomas.

Figure 3

PET-CT choline showing two choline-avid lesions on the lower part of both the left and right thyroid lobe. Fitting the typical localisations of parathyroid adenomas.

Figure 4

Intraoperative image of excised parathyroid adenoma.