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2013, Number 3

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Rev Endocrinol Nutr 2013; 21 (3)

Acute Pancreatitis in primary hyperparathyroidism

Manguilar LA, Cruz SRC, González VB, Vargas OG, Mercado AM, Ferreira HA, Mendoza ZV

Language: Spanish
References: 23
Page: 132-137
PDF size: 290.53 Kb.


ABSTRACT

Patients with primary hyperparathyroidism (PHPT) and hypercalcemia are 10 times more susceptible than general population to present acute pancreatitis. Pancreatitis is a rare complication of PHPT with a prevalence of 1.5 to 13%. Three possible pathogenetic mechanisms have been described: 1) hypercalcemia leads to de novo activation of trypsinogen to trypsin, resulting in pancreatic autodigestion and pancreatitis, 2) hypercalcemia favors pancreatic stones formation and ductal obstruction; and 3) several mutations in some genes, such as SPINK1 (serine protease inhibitor Kazal type 1), CFTR (cystic fibrosis transmembrane regulator) and CASR (calcium sensing receptor), present in situations of hypercalcemia. Objective: To describe the prevalence and clinical characteristics of patients with PHPT and acute pancreatitis in the past three years in the Mineral Metabolism Clinic at Hospital de Especialidades, Centro Médico Nacional Siglo XXI. Patients and methods: A retrospective study of patients with PHPT treated in this reference center was conducted. Of the 150 patients, six had acute pancreatitis. Demographic, clinical, biochemical and histopathological factors were analyzed. Results: Six patients had pancreatitis (4%), four cases were hemorrhagic pancreatitis and two inflammatory pancreatitis; the patients’ an average age was 48.5 years; five of the six patients were women. The concentrations of PTHi were 623.5 ± 185 pg/mL (versus 194 ± 63 pg/mL, p = 0.01), median serum calcium was 12.75 ± 1.8 mg/dL (versus 11.3 ± 1.23 mg/dL, p = 0.05). It is also notorious that the largest diameter of parathyroid adenoma was 3 ± 1.7 cm (versus 1.8 ± 0.4 cm, p = 0.01). Conclusion: Pancreatitis is a rare complication of PHPT. In our series the prevalence was 4%. Patients with PHPT have a more severe clinical presentation and adenomas are larger. Besides hypercalcemia and higher concentrations of parathyroid hormone (PTHi), other risk factors as genetic and environmental factors may increase the risk of pancreatitis in these patients.


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