Carnaille B, Oudar C, Pattou F, Combemale F, Rocha J, Proye C
Department of General and Endocrine Surgery, University Hospital, Lille, France.
Aust N Z J Surg. 1998 Feb;68(2):117-9. doi: 10.1111/j.1445-2197.1998.tb04719.x.
Pancreatitis is associated with primary hyperparathyroidism (PHPT) in 1.5-7% of cases. The relationship of cause and effect between the two diseases has been debated.
To evaluate this relationship, the clinical, biochemical and pathological data on 1435 patients operated on for hyperparathyroidism (HPT) over the past 30 years were retrospectively reviewed. A total of 1224 of these patients had biologically proven and cured PHPT and 211 patients had renal HPT (RHPT). The diagnosis of pancreatitis (PTS) was based on a high serum amylase level and/or abnormalities on ultrasound or computed tomography (CT) scan explorations. Only patients without biliary stones were included in the PTS group associated with HPT.
A total of 3.2% (n = 40) of patients with PHPT had PTS, which was acute in 18 cases, subacute in 8 cases and chronic in 14 cases. This rate of PTS is higher than in a random hospital population. Surgical cure of HPT was followed by the spontaneous healing of 17/18 acute PTS, whereas six of the 22 patients with subacute or chronic PTS developed complications due to the evolution of their disease (diabetes, pancreatic duct stenosis treated by surgery). A single diseased gland was found in 27 patients with PTS, which is in favour of primary parathyroid disease, being responsible for, and not a consequence of, PTS. Only the serum calcium (13.0 vs 12.1 g/dL) level was significantly increased in PHPT patients with PTS, when compared to those without PTS. The calcium level is probably of major importance in the development of PTS, which was never encountered in 211 patients with RHPT, who had low calcium and high PTH levels.
The data suggest that (i) the PTS-PHPT association is not incidental; (ii) PTS is the consequence and not the cause of PHPT; (iii) hypercalcaemia seems to be a major factor in the development of PTS in PHPT patients; and (iv) cure of PHPT leads to the healing of acute PTS, whereas it does not affect the evolution of subacute and chronic PTS.
胰腺炎在1.5% - 7%的病例中与原发性甲状旁腺功能亢进症（PHPT）相关。两种疾病之间的因果关系一直存在争议。
为评估这种关系，回顾性分析了过去30年中1435例因甲状旁腺功能亢进症（HPT）接受手术治疗患者的临床、生化和病理数据。其中共有1224例患者经生物学证实并治愈了PHPT，211例患者患有肾性甲状旁腺功能亢进症（RHPT）。胰腺炎（PTS）的诊断基于血清淀粉酶水平升高和/或超声或计算机断层扫描（CT）检查异常。与HPT相关的PTS组仅纳入无胆结石的患者。
PHPT患者中共有3.2%（n = 40）发生PTS，其中急性18例，亚急性8例，慢性14例。PTS发生率高于随机医院人群。HPT手术治愈后，17/18例急性PTS自发愈合，而22例亚急性或慢性PTS患者中有6例因病情进展出现并发症（糖尿病、手术治疗的胰管狭窄）。27例PTS患者发现单个病变腺体，这支持原发性甲状旁腺疾病是PTS的病因而非结果。与无PTS的PHPT患者相比，有PTS的PHPT患者仅血清钙水平（13.0 vs 12.1 g/dL）显著升高。钙水平可能在PTS发生中起主要作用，211例RHPT患者钙水平低且甲状旁腺激素水平高，从未发生PTS。
数据表明：（i）PTS与PHPT的关联并非偶然；（ii）PTS是PHPT的结果而非原因；（iii）高钙血症似乎是PHPT患者发生PTS的主要因素；（iv）PHPT治愈可使急性PTS愈合，但不影响亚急性和慢性PTS的进展。
