Recurrent pancreatitis associated with normocalcemia, parathyroid hyperplasia, and increased serum parathormone
Joseph T. Danzi, M.D.
Department of Internal Medicine
Richard G. Farmer, M.D.
Department of Gastroenterology
Caldwell B. Esselstyn, M.D.
Department of General Surgery
In recent years, normocalcemic primary hyperparathyroidism has been recognized more frequently. Usually, these patients have recurrent renal calculi and normal serum calcium values.1, 2 The association of pancreatitis with hyperpara-thyroidism has been recognized since 1940.3 Reviews by Mixter et al4 and by Turchi et al,5 in 1962, stressed the importance of pancreatitis as a clue in the diagnosis of hyperparathyroidism. A nearly normal serum calcium value and a decreased serum phosphorus level in cases of acute pancreatitis should arouse suspicion of hyperfunctioning parathyroid glands. Ballon et al6 reported a case of recurrent pancreatitis associated with a parathyroid adenoma in a normocalcemic patient.
This case of severe relapsing pancreatitis was associated with a normal serum calcium level, parathyroid hyperplasia, and elevation of serum parathormone level to three times the normal range for the patient’s age. The aim of this report is to alert clinicians to the relationship of pancreatitis with normocalcemia and to speculate on the role of parathormone in the etiology of the pancreatitis.
A 14-year-old white girl was referred for evaluation of recurrent epigastric pain. The patient had a history of six episodes of epigastric pain requiring six hospitalizations. The pain was severe, nonradiating, and was associated with severe nausea, vomiting, and a low grade fever. There was no jaundice or diarrhea. Each episode of pain persisted 5 to 6 days. During her first hospitalization an appendectomy was performed, and there were no pathological findings. In the intervals between attacks, the patient was asymptomatic. There was no family history of gallbladder disease and pancreatic disease.