Persistent challenges in the diagnosis of acute pancreatitis due to primary hyperparathyroidism during pregnancy

Figure 4 Algorithm for primary hyperparathyroidism-induced acute pancreatitis during pregnancy. Pregnant patients presenting with symptoms such as anorexia, abdominal pain, nausea, vomiting, and constipation from the 20^th week of pregnancy should undergo careful clinical evaluation. If acute pancreatitis is suspected, tests including amylase, lipase, and imaging studies should be performed, with abdominal ultrasound being the first-line test because of its low cost and lack of fetal impact. After acute pancreatitis is diagnosed, biochemical and imaging tests should be conducted to confirm the presence of primary hyperparathyroidism. In patients with symptoms of hypercalcemia due to primary hyperparathyroidism, parathyroidectomy should be considered. Additionally, the fetal condition should be assessed. If fetal distress is present, treatment with tocolytic drugs should be initiated, and an emergency cesarean section should be considered if initial medical management is ineffective. ¹Consider using a low radiation dose with patient consent when an magnetic resonance imaging cannot be performed; ²When the patient has a family history, it is young and is able to undergo the procedure; ³Perform when MRI cannot be detected/used, with patient consent, and using a low radiation dose. ⁹⁹mTc: 99m Technetium; CT: Computed tomography; MRI: Magnetic resonance imaging; US: Ultrasound.