Parathyroid adenoma in a young female presenting as recurrent acute pancreatitis with a brown tumour of the mandible-A case study.

INTRODUCTION: Primary hyperparathyroidism is usually seen in females above the age of 50 years, with a prevalence of 21/1000,(1) whereas the incidence in patients aged 12-28 years is less than 5%.(2) A solitary adenoma is responsible for 80% of cases of primary hyperparathyroidism.(3) Primary hyperparathyroidism is most commonly asymptomatic.(4) The incidence of acute pancreatitis associated with hyperparathyroidism is less than 10%.(5,6) The incidence of hyperparathyroidism associated with a Brown tumour is less than 5%.(7) PRESENTATION OF CASE: A 19 year old female patient presented with recurrent acute pancreatitis and swelling over the mandible. Complete investigative workup revealed a solitary parathyroid adenoma causing hyperparathyroidism. Surgical exploration with excision of the parathyroid adenoma was performed, following which the patient recovered uneventfully.

DISCUSSION: The patient was initially managed as a case of acute pancreatitis, and although not suspected initially, a high index of suspicion for hyperparathyroidism developed after a biopsy of the mandibular swelling showed the presence of osteoclastic giant cells indicating the possibility of a Brown tumour. Further investigations then revealed the presence of a solitary parathyroid adenoma with coexistent hyperparathyroidism which was then managed surgically.

CONCLUSION: The young age of the patient, and her presentation with acute pancreatitis and a Brown tumour of the mandible make this an extremely rare presentation of parathyroid adenoma.