Rashmi K G, Kamalanathan Sadishkumar, Sahoo Jayaprakash, Naik Dukhabandhu, Mohan Pazhanivel, Pottakkat Biju, Kar Sitanshu Sekhar, Palui Rajan, Roy Ayan
Department of Endocrinology, JIPMER, Puducherry 605006, India.
Department of Medical Gastroenterology, JIPMER, Puducherry 605006, India.
World J Gastrointest Pharmacol Ther. 2022 Jul 5;13(4):47-56. doi: 10.4292/wjgpt.v13.i4.47.
Acute pancreatitis (AP) presenting as an initial manifestation of primary hyperparathyroidism (PHPT) is uncommon, and its timely diagnosis is crucial in preventing recurrent attacks of pancreatitis.
To determine the clinical, biochemical, and radiological profile of PHPT patients presenting as AP.
This is a retrospective observational study, 51 consecutive patients admitted with the diagnosis of PHPT during January 2010 and October 2021 at a tertiary care hospital in Puducherry, India was included. The diagnosis of AP was established in the presence of at least two of the three following features: abdominal pain, levels of serum amylase or lipase greater than three times the normal, and characteristic features at abdominal imaging.
Out of the 51 consecutive patients with PHPT, twelve (23.52%) had pancreatitis [5 (9.80%) AP, seven (13.72%) chronic pancreatitis (CP)]. PHPT with AP (PHPT-AP) was more common among males with the presentation at a younger age (35.20 ± 16.11 49.23 ± 14.80 years, = 0.05) and lower plasma intact parathyroid hormone (iPTH) levels [125 (80.55-178.65) 519.80 (149-1649.55, = 0.01)] compared to PHPT without pancreatitis (PHPT-NP). The mean serum calcium levels were similar in both PHPT-AP and PHPT-NP groups [(11.66 ± 1.15 mg/dL) (12.46 ± 1.71 mg/dL), = 0.32]. PHPT-AP also presented with more gastrointestinal symptoms like abdominal pain, nausea, and vomiting with lesser skeletal and renal manifestations as compared to patients with PHPT-NP.
AP can be the only presenting feature of PHPT. Normal or higher serum calcium levels during AP should always draw attention towards endocrine causes like PHPT.
急性胰腺炎（AP）作为原发性甲状旁腺功能亢进症（PHPT）的初始表现并不常见，及时诊断对于预防胰腺炎复发至关重要。
确定以AP形式表现的PHPT患者的临床、生化和放射学特征。
这是一项回顾性观察研究，纳入了2010年1月至2021年10月期间在印度本地治里一家三级护理医院连续收治的51例诊断为PHPT的患者。当出现以下三个特征中的至少两个时可确诊为AP：腹痛、血清淀粉酶或脂肪酶水平高于正常上限三倍、腹部影像学特征。
在这51例连续的PHPT患者中，12例（23.52%）患有胰腺炎[5例（9.80%）为AP，7例（13.72%）为慢性胰腺炎（CP）]。与无胰腺炎的PHPT（PHPT-NP）相比，伴AP的PHPT（PHPT-AP）在男性中更常见，发病年龄较轻（35.20±16.11岁对49.23±14.80岁，P = 0.05），血浆完整甲状旁腺激素（iPTH）水平较低[125（80.55 - 178.65）对519.80（149 - 1649.55），P = 0.01]。PHPT-AP组和PHPT-NP组的平均血清钙水平相似[（11.66±1.15mg/dL）对（12.46±1.71mg/dL），P = 0.32]。与PHPT-NP患者相比，PHPT-AP还表现出更多的胃肠道症状，如腹痛、恶心和呕吐，而骨骼和肾脏表现较少。
AP可能是PHPT的唯一表现特征。AP期间血清钙水平正常或升高时应始终关注诸如PHPT等内分泌病因。
