Hyperparathyroidism presenting as pancreatitis or complicated by postoperative pancreatitis

BACKGROUND: The association of hyperparathyroidism with acute pancreatitis either pre-operatively or postoperatively has been questioned in recent overseas literature. METHODS: A review of medical records and histology reports in the Royal Hobart Hospital from 1971 to 1993 was carried out to identify all cases of acute pancreatitis associated with primary hyperparathyroidism. RESULTS: Seven cases are presented, six with histological confirmation, of hyperparathyroidism associated with pancreatitis in a period when 137 confirmed cases of primary hyperparathyroidism were treated. None of these patients had gallstones. In two, alcohol abuse may have been the aetiological factor. Five patients had successful neck exploration and none of them have experienced any further attacks including a 25 year old who had four hospitalizations and one laparotomy for pancreatitis in the year before parathyroidectomy 12 years ago. Two patients died from acute pancreatitis, one without exploration and the other with a mediastinal parathyroid adenoma that was not located at surgery. CONCLUSIONS: Most parathyroid surgeons would proceed to mediastinotomy, if necessary, at initial exploration in a patient with previous hypercalcaemic crisis. This should also be considered in patients with a history of acute pancreatitis.