Primary hyperparathyroidism and pancreatitis
Tóm tắt
The true association between primary hyperparathyroidism (PHPT) and pancreatitis continues to be controversial. In this study, we present clinical data, investigative profile, management and follow-up of PHPT patients with pancreatitis and compare this group with PHPT patients without pancreatitis. Records of 242 patients with PHPT managed at our center over 24 years were retrospectively analyzed for demographic and laboratory data. The diagnosis of pancreatitis was entertained in the presence of at least two of the three following features: abdominal pain, levels of serum amylase greater than three times the normal or characteristic features at imaging. Fifteen (6.19%) of the 242 consecutive patients with PHPT had had pancreatitis. Fourteen patients (93.3%) had acute pancreatitis (AP), while one patient had chronic calcific pancreatitis. Over half (8 of 14) of the patients with AP had at least two episodes of pancreatitis. Pancreatitis was the presenting symptom in 14 (93.3%) patients. None of the pancreatitis cases had additional risk factors for pancreatitis. PHPT patients with pancreatitis had significantly higher serum calcium and ALP than PHPT patients without pancreatitis. After successful parathyroidectomy, 14 patients had no further attacks of pancreatitis during a median follow-up of 16 months (range 2–41 months), while recurrence of pancreatitis was seen in one patient. We conclude that pancreatitis can be the only presenting complaint of PHPT. Our study highlights the importance of fully investigating for PHPT in any pancreatitis patient with high normal or raised serum calcium level, especially in the absence of other common causes of pancreatitis.
Tài liệu tham khảo
Ruda JM, Hollenbeak CS, Stack BC Jr (2005) A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 132:359–372
AACE/AAES Task Force on Primary Hyperparathyroidism (2005) The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract 11:49–54
Misgar RA, Dar PM, Masoodi SR, Ahmad M, Wani KA, Wani AI, Bashir MI (2016) Clinical and laboratory profile of primary hyperparathyroidism in Kashmir Valley: a single-center experience. Indian J Endocr Metab 20:696–701
Misgar RA, Sehgal A, Masoodi SR, Wani AI, Bashir MI, Malik AA, Wani MA, Wani MM, Wani IA (2019) A comparison between silent and symptomatic renal stones in primary hyperparathyroidism. Indian J Endocr Metab 23:46–49
Misgar RA, Mathew V, Pandit K, Chowdhury S (2011) Primary hyperparathyroidism presenting as recurrent acute pancreatitis: a case report and review of literature. Indian J Endocr Metab 15:54–56
Smith FB, Cook RT (1940) Acute fatal hyperparathyroidism. Lancet 2:650
Jacob JJ, John M, Thomas N, Chacko A, Cherian R, Selvan B, Nair A, Seshadri M (2006) Does hyperparathyroidism cause pancreatitis? A south indian experience and a review of published work. Anz j surg 76:740–744
Agarwal A, George RK, Gupta SK, Mishra SK (2003) Pancreatitis in patients with primary hyperparathyroidism. Indian J Gastroenterol 22:224–225
Carnaille B, Oudar C, Pattou F, Combemale F, Rocha J, Proye C (1998) Pancreatitis and primary hyperparathyroidism: forty cases. Aust N Z J Surg 68:117–119
Koppelberg T, Bartsch D, Printz H, Hasse C, Rothmund M (1994) Pancreatitis in primary hyperparathyroidism (pHPT) is a complication of advancedpHPT. Dtsch Med Wochenschr 119:719–724
Bhadada SK, Udawat HP, Bhansali A, Rana SS, Sinha SK, Bhasin DK (2008) Chronic pancreatitis in primary hyperparathyroidism: comparison with alcoholic and idiopathic chronic pancreatitis. J Gastroenterol Hepatol 23:959–964
Bai HX, Geifer M, Patel M, Orabi AI, Husain SZ (2012) The association of primary hyperthyroidism with pancreatitis. J clinical Gastroenterol 46:656–661
Dubost C, Testart J, Choquart P, Kaswin R (1979) Les pancreatites de l'hyperparathyro'idie. Gastroenterol Clin Biol 3:621–630
Goebell H (1976) The role of calcium in pancreatic secretion and disease. Acta Hepato gastroenterol 23:151–161
Bess MA, Edis AJ, van Heerden JA (1980) Hyperparathyroidism and pancreatitis. Chance or a causal association? JAMA 243:246–247
Khoo TK, Vege SS, Abu-Lebdeh HS, Ryu E, Nadeem S, Wermer RA (2009) Acute pancreatitis in primary hyperparathyroidism: a population-based study. J Clin Endocrinol Metab 94:2115–2118
Sisman P, Avci M, Akkurt A, Sahin AB, Gul OO, Ersoy C, Erturk E (2018) The effect of primary hyperparathyroidism on pancreatic exocrine function. J Endocrinol Invest 41:293–298
Prinz RA, Aranha GV (1985) The association of primary hyperparathyroidism and pancreatitis. Am Surg 51:325–329
Shepherd JJ (1996) Hyperparathyroidism presenting as pancreatitis or complicated by postoperative pancreatitis. Aust N Z J Surg 66:85–87
FelderbauerP KE, Fendrich V et al (2011) Multifactorial genesis of pancreatitis in primary hyperparathyroidism: evidence for “protective” (PRSS2) and “destructive” (CTRC) genetic factors. Exp Clin Endocrinol Diabetes 119:26–29
Bist SS, Ahuja V, Agrawal V, Modi S (2016) Recurrent acute pancreatitis: a diagnostic clue to primary hyperparathyroidism. Iran J Med Sci 41:361–362
Chowdhury SD, Kurien RT, Pal S et al (2014) Acute pancreatitis and hyperparathyroidism: a case series. Indian J Gastroenterol 33:175–177
Haverback BJ, Dyce D, Bundy H (1960) Trypsin, trypsinogen, and trypsin inhibitor in human pancreatic juice: mechanism for pancreatitis associated with hyperparathyroidism. Am J Med 29:424–433
Cope O, Culver PJ, Mixter CG Jr, Nardi GL (1957) Pancreatitis, a diagnostic clue to hyperparathyroidism. Ann Surg 145:857–863
Felderbauer P, Karakas E, Fendrich V, Bulut K, Horn T, Lebert R, Holland- Letz T, Schmitz F, Bartsch D, Schmidt WE (2008) Pancreatitis risk in primary hyperparathyroidism: relation to mutations in the SPINK1 trypsin inhibitor (N34S) and the cystic fibrosis gene. Am J Gastroenterol 103:368–374
Sitges-Serra A, Alonso M, de Lecea C, Gores PF, Sutherland DE (1988) Pancreatitis and hyperparathyroidism. Br J Surg 75:158–160