Asian Journal of Case Reports in Surgery

Introduction: Acute pancreatitis is a common condition with significant morbidity and mortality. While the most common causes are gallstones and alcohol, there are rarer causes such as primary hyperparathyroidism. Most patients with primary hyperparathyroidism are asymptomatic while symptomatic patients present with bone disease and renal manifestations. They can still present with acute pancreatitis, mostly in advanced disease. Infrequently, it can be the first presentation of primary hyperparathyroidism as depicted in our case.

Case Presentation: We herein report a case of a 20-year-old male presenting with epigastric pain and vomiting, relieved by bending forward.

Clinical Findings and Investigations: On examination, the patient was in pain but hemodynamically stable with a soft abdomen. Initial investigations found elevated serum amylase levels and imaging confirms the acute pancreatitis. However initial etiology screening is normal. Further investigations revealed hypercalcemia. A diagnosis of primary hyperparathyroidism and parathyroid adenoma was made based on an elevated parathyroid hormone level and USS                neck showing a left inferior parathyroid adenoma. Technetium-99m methoxy-isobutyl-isonitrile scintigraphy was used to localize the parathyroid adenoma.

Intervention and Outcome: The patient underwent left lower parathyroidectomy. After the surgery, he had a normal parathyroid hormone level with no further episodes of acute pancreatitis. 

Relevance and Impact: Acute pancreatitis is a rare presentation of primary hyperparathyroidism. Primary hyperparathyroidism should be suspected in patients with acute pancreatitis with no common etiologies. Diagnosis is important since parathyroidectomy is a definitive treatment method which can prevent progression into chronic pancreatitis.