Primary hyperparathyroidism presenting as acute pancreatitis: An institutional experience with review of the literature

Table 1 Demography, clinical and biochemical profile of all primary hyperparathyroidism patients

Parameters	n = 51
Age (yr)	47.80 ± 14.51
Female gender	31 (60.78%)
Sex (female: male)	1.55:1 (female 31, male 20)
Bone pain	28 (54.90%)
Fracture	04 (7.84%)
Pain abdomen	22 (43.13%)
Nausea and vomiting	16 (31.37%)
Weight loss	12 (23.52%)
Fatigue and weakness	25 (49.01%)
Anorexia	16 (31.37%)
Psychiatric features	06 (11.76%)
Nephrolithiasis	17 (33.33%)
Nephrocalcinosis	11 (21.56%)
Cholelithiasis	04 (7.84%)
Serum creatinine (mg/dL)	0.80 (0.63-1.14)
Serum corrected calcium(mg/dL)	12.41 ± 1.58
Serum phosphorous (mg/dL)	2.7 (2.2-3.17)
Serum magnesium (mg/dL)	1.80 (1.7-2)
Serum albumin (g/dL)	3.90 (3.5-4.2)
Serum alkaline phosphatase (IU/L)	196 (127.5-502)
Serum 25-OH vitamin D (ng/mL)	18.09 ± 9.93
Plasma iPTH (pg/mL)	328.10 (143-1111)

PHPT: Primary hyperparathyroidism; iPTH: Intact parathyroid hormone.

Table 2 Comparison between primary hyperparathyroidism without pancreatitis and primary hyperparathyroidism with acute pancreatitis

Parameters	PHPT-NP, n = 39	PHPT-AP, n = 05	P value
Age (yr)	49.23 ± 14.80	35.20 ± 16.11	0.05
Female gender	27 (69.23%)	0
Bone pain	22 (56.41%)	1 (20%)	0.17
Fracture	04 (10.26%)	0
Pain abdomen	10 (25.64%)	5 (100%)	< 0.01
Nausea and vomiting	05 (12.82%)	5 (100%)	< 0.01
Weight loss	06 (15.38%)	1 (20%)	1
Fatigue and weakness	18 (46.15%)	2 (40%)	1
Anorexia	06(15.38%)	4 (80%)	< 0.01
Psychiatric features	03 (7.69%)	0
Nephrolithiasis	14 (35.89%)	0
Nephrocalcinosis	09 (23.07%)	0
Cholelithiasis	02 (5.12%)	1 (20%)	0.31
Serum creatinine(mg/dL)	0.80 (0.60-1.19)	0.74 (0.66-0.89)	0.66
Serum corrected calcium(mg/dL)	12.46 ± 1.71	11.66 ± 1.15	0.32
Serum phosphorous (mg/dL)	2.7 (2.2-3.17)	2.7 (2.02-2.90)	0.62
Serum magnesium (mg/dL)	1.82 ± 0.33	1.76 ± 0.34	0.72
Serum albumin (g/dL)	3.90 (3.5-4.1)	4.2 (3.7-4.75)	0.18
Serum ALP (IU/L)	242 (148-764.5)	112 (106.25-147)	0.03
Serum 25-OH vitamin D(ng/mL)	15.48 (10.24-21.37)	25.91 (13.88-31.72)	0.33
Plasma iPTH (pg/mL)	519.80(149-1649.55)	125 (80.55-178.65)	0.01

PHPTAP: Primary hyperparathyroidism with acute pancreatitis; PHPT-NP: Primary hyperparathyroidism without pancreatitis; ALP: Alkaline phosphatase; iPTH: Intact parathyroid hormone.

Table 3 Biochemical and imaging findings of patients with primary hyperparathyroidism with acute pancreatitis

No	Age	Sex	S Amylase (IU/mL)	S lipase (IU/mL)	Imaging	Modified CT severity index
1	46	M	160	770	Acute pancreatitis on CECT	4
2	27	M	1487	NA	Acute interstitial pancreatitis on MRCP	NA
3	20	M	NA	NA	Acute pancreatitis on CECT	6
4	25	M	514	260	Acute necrotizing pancreatitis on CECT	6
5	58	M	1276	1365	Acute necrotizing pancreatitis on CECT	8

PHPT-AP: Primary hyperparathyroidism with acute pancreatitis; iPTH: Intact parathyroid hormone; MRCP: Magnetic resonance cholangiopancreatography; CECT: Contrast enhanced computed tomography; NA: Details not available.

Table 4 Rates of pancreatitis among patients with primary hyperparathyroidism in different studies

Ref.	Country	Number of PHPT Patients	PHPT with pancreatitis n (%)	Type of pancreatitis
Bess et al[7]	USA	1153	17 (1.5)	10 AP (0.86%), 7 CP
Sitges-Serra et al[8]	Spain	86	7 (8.1)	3 AP (3.4%), 1 RP, 3 CP
Koppelberg et al[9]	Germany	234	13 (5.6)	9 AP (3.8%), 4 CP
Shepherd et al[12]	Australia	137	7 (5.1)	All AP (5.1%)
Carnaille et al[10]	France	1224	40 (3.3)	18 AP (1.47), 8 RP, 14 CP
Agarwal et al[32]	India	87	6 (6.9)	5 RP, 1 CP
Jacob et al[13]	India	101	13 (12.9)	6 AP (5.94%), 6 RP, 1 CP
Bhadada et al[29]	India	59	9 (15.3)	All CP
Khoo et al[33]	USA	684	10 (1.5)	All AP (1.5%)
Felderbauer et al[22]	Germany	1259	57 (4.52)	16 AP (1.27%), 15 CP, 26 NA
Arya et al[11]	India	218	35 (16)	18 AP (8.25%), 17 CP
Misgar et al[5]	India	242	15 (6.19)	14 AP (5.78%), 1 CP
Total		5484	229 (4.17)	111 (2.02) AP

AP: Acute pancreatitis; CP: Chronic pancreatitis; NA: Details Not available; PHPT: Primary hyperparathyroidism; RP: Recurrent pancreatitis.