Serial Calcium Monitoring Revealed Primary Hyperparathyroidism in Severe Acute Pancreatitis: A Case Report.

BACKGROUND

Hypocalcemia is commonly monitored as a severity marker in acute pancreatitis, whereas hypercalcemia is an uncommon but important clue to primary hyperparathyroidism (PHPT).

CASE PRESENTATION: A 42-year-old man without gallstones, tumor, or alcohol use developed severe acute pancreatitis, with organ failure persisting beyond 48 h. His corrected calcium level was at the lower reference limit on admission but rose from Day 3, exceeded the upper reference limit on Day 4, and reached a peak of 18 mg/dL on Day 21. Intact parathyroid hormone was elevated, and cervical ultrasonography showed a parathyroid mass. PHPT was diagnosed on Day 24. Severe hypercalcemia with concomitant renal dysfunction required continuous hemodiafiltration, cinacalcet, elcatonin, and zoledronic acid. Parathyroidectomy on Day 35 confirmed parathyroid adenoma, and serum calcium normalized on Day 36. He required drainage of intra-abdominal abscesses and was transferred for rehabilitation on Day 170.

CONCLUSION

In patients with severe acute pancreatitis, a calcium level that is not elevated on admission does not exclude PHPT. A rise in serum calcium during the clinical course can be an important diagnostic clue prompting re-evaluation for PHPT.