Delayed diagnosis of primary hyperparathyroidism in a patient with recurrent acute pancreatitis: a case report

Primary hyperparathyroidism (PHPT) is an uncommon but clinically relevant metabolic condition associated with acute pancreatitis. We report a 32-year-old man with recurrent acute pancreatitis over approximately 4 years in whom coexisting PHPT was eventually recognized. Long-term heavy beer consumption and cholelithiasis represented important competing etiological factors. Although the exact amount and frequency of alcohol consumption could not be reliably quantified from the medical record, the patient had recently stopped drinking before the hospitalization leading to the diagnosis of PHPT. Serial abdominal ultrasonography and computed tomography did not demonstrate choledocholithiasis or biliary duct dilatation, and subsequent follow-up imaging showed no evidence of persistent biliary obstruction. Retrospective review of previous laboratory results revealed recurrent hypercalcemia and hypophosphatemia that had not prompted evaluation of parathyroid function. Subsequent testing demonstrated markedly elevated parathyroid hormone levels, and parathyroid scintigraphy and neck ultrasonography localized a right inferior parathyroid lesion. Right inferior parathyroidectomy was performed, and histopathological examination confirmed a parathyroid adenoma. On postoperative day 1, parathyroid hormone decreased markedly to 1.7 pg/mL, with serum calcium of 2.57 mmol/L. During long-term clinical follow-up, including telephone follow-up at approximately 1 and 2 years after surgery and at the most recent contact, the patient remained in good general condition without recurrent abdominal pain or acute pancreatitis. This case suggests that PHPT should be considered in patients with recurrent pancreatitis and persistent hypercalcemia, even when other potential etiological factors are present.