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primary hyperparathyroidism-induced acute pancreatitis in pregnancy:A systematic review with a diagnostic-treatment algorithm

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World Journal of Gastroenterology 2024年第32期30卷 3755-3765页

作者： Goran Augustin Quirino Lai Maja Cigrovski Berkovic Department of Surgery University Hospital Centre Zagreb and School of Medicine University of ZagrebZagreb 10000Croatia General Surgery and Organ Transplantation Unit Department of SurgerySapienza University of RomeRome 00018Italy Department for Sport and Exercise Medicine Faculty of KinesiologyUniversity of ZagrebZagreb 10000Croatia

BACKGROUND primary hyperparathyroidism(PHPT)-induced acute pancreatitis(AP)during pregnancy has rarely been *** to this rarity,there are no diagnostic or treatment algorithms for pregnant *** To determine appropriate diagnostic methods,therapeutic options,and factors related to maternal and fetal outcomes for PHPT-induced AP in *** A literature search of articles in English,Japanese,German,Spanish,and Italian was performed using PubMed(1946-2023),PubMed Central(1900-2023),and Google *** Preferred Reporting Items for Systematic reviews and Meta-Analyses(PRISMA)protocol was *** search terms included“pancreatite acuta,”“iperparatiroidismo primario,”“gravidanza,”“travaglio,”“puerperio,”“postpartum,”“akute pankreatitis,”“primärer hyperparathyreoidismus,”“Schwangerschaft,”“Wehen,”“Wochenbett,”“pancreatitis aguda,”“hiperparatiroidismo primario,”“embarazo,”“parto,”“puerperio,”“posparto,”“acute pancreatitis,”“primary hyperparathyroidism,”“pregnancy,”“labor,”“puerperium,”and“postpartum.”Additional studies were identified by reviewing the reference lists of retrieved ***,imaging,surgical,obstetric,and outcome data were *** Fifty-four cases were collected from the 51 *** median maternal age was 29 ***-induced AP starts at the 20th gestational week;higher gestational weeks were seen in mothers who died(mean gestational week 28).Median values of amylase(1399,Q1-Q3=519-2072),lipase(2072,Q1-Q3=893-2804),serum calcium(3.5,Q1-Q3=3.1-3.9),and parathormone(PTH)(384,Q1-Q3=123-910)were *** 46 cases,adenoma was the cause of PHPT,followed by 2 cases of carcinoma and 1 case of *** the remaining 5 cases,the diagnosis was not *** ultrasound was positive in 34 cases,whereas sestamibi was performed in 3 cases,and neck computed tomography or magnetic resonance imaging was performed in 9 cases(the enlarged parathyroid gland was not localized in 3 cases).Surgery was the prefer

关键词： primary hyperparathyroidism Acute pancreatitis Pregnancy Diagnosis Maternal mortality Fetal mortality Algorithm

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primary hyperparathyroidism presenting as acute gallstone pancreatitis

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Chinese Medical Journal 2010年第10期123卷 1351-1352页

作者： HE Jian-hong ZHANG Quan-bao LI Yu-min ZHU You-quan LI Xun SHI Bin Department II of General Surgery First Hospital of Lanzhou University Lanzhou Gansu 730000 China Surgical Intensive Care Unit First Hospital of Lanzhou University Lanzhou Gansu 730000 China

primary hyperparathyroidism （PHPT） is a generalized disorder of calcium metabolism resulting from an abnormally high level of serum calcium and an increased level of parathormone （PTH）. 1,2 Traditionally, symptomatic PHPT patients present with a variety of disorders including fatigue, amyotrophy, memory impairment, emotional instability, hallucination, irritation, loss of consciousness, abdominal distention, nausea,

关键词： primary hyperparathyroidism hypercalcaemic crisis acute pancreatitis

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Acute pancreatitis with hypercalcemia caused by primary hyperparathyroidism associated with paraneoplastic syndrome:A case report and review of literature

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World Journal of Clinical Cases 2021年第29期9卷 8906-8914页

作者： Long Yang Yue Lin Xiang-Qun Zhang Bo Liu Jun-Yu Wang Department of Emergency Medicine Clinical Research Center Beijing Chao-Yang HospitalCapital Medical University&Beijing Key Laboratory of Cardiopulmonary Cerebral ResuscitationBeijing Chaoyang District Gongti South Street 100020China Department of Radiology China-Japan Friendship HospitalBeijing 100029China

BACKGROUND Although acute pancreatitis associated with hyperparathyroidism has occasionally been reported,acute pancreatitis with metabolic encephalopathy caused by hyperparathyroidism combined with paraneoplastic syndrome is an extremely rare entity and poorly described in the *** SUMMARY We present a case of a 56-year-old female with upper abdominal discomfort and intermittent nausea and vomiting for 1 wk,without apparent abdominal pain or bloating,no jaundice and decreased blood pressure at the *** patient was ultimately diagnosed with moderately severe acute pancreatitis(according to the revised Atlanta classification of acute pancreatitis)combined with metabolic encephalopathy secondary to hypercalcemia caused by primary hyperparathyroidism associated with paraneoplastic *** active treatment of acute pancreatitis,massive fluid resuscitation,resection of parathyroid and uterine malignant tumors,neoadjuvant chemotherapy and other treatments,her serum calcium eventually returned to the normal *** patient was successfully discharged from *** This is the first case of acute pancreatitis caused by primary hyperparathyroidism associated with paraneoplastic syndrome.

关键词： Acute pancreatitis Humoral hypercalcemia primary hyperparathyroidism Paraneoplastic syndrome Case report

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primary hyperparathyroidism presenting as acute pancreatitis: An institutional experience with review of the literature

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2022年第4期13卷 47-56页

作者： K G Rashmi Sadishkumar Kamalanathan Jayaprakash Sahoo Dukhabandhu Naik Pazhanivel Mohan Biju Pottakkat Sitanshu Sekhar Kar Rajan Palui Ayan Roy Department of Endocrinology JIPMERPuducherry 605006India Department of Medical Gastroenterology JIPMERPuducherry 605006India Department of Surgical Gastroenterology JIPMERPuducherry 605006India Department of Preventive and Social Medicine JIPMERPuducherry 605006India

BACKGROUND Acute pancreatitis(AP)presenting as an initial manifestation of primary hyperparathyroidism(PHPT)is uncommon,and its timely diagnosis is crucial in preventing recurrent attacks of *** To determine the clinical,biochemical,and radiological profile of PHPT patients presenting as *** This is a retrospective observational study,51 consecutive patients admitted with the diagnosis of PHPT during January 2010 and October 2021 at a tertiary care hospital in Puducherry,India was *** diagnosis of AP was established in the presence of at least two of the three following features:abdominal pain,levels of serum amylase or lipase greater than three times the normal,and characteristic features at abdominal *** Out of the 51 consecutive patients with PHPT,twelve(23.52%)had pancreatitis[5(9.80%)AP,seven(13.72%)chronic pancreatitis(CP)].PHPT with AP(PHPT-AP)was more common among males with the presentation at a younger age(35.20±16.11 vs 49.23±14.80 years,P=0.05)and lower plasma intact parathyroid hormone(iPTH)levels[125(80.55-178.65)vs 519.80(149-1649.55,P=0.01)]compared to PHPT without pancreatitis(PHPT-NP).The mean serum calcium levels were similar in both PHPT-AP and PHPT-NP groups[(11.66±1.15 mg/dL)vs(12.46±1.71 mg/dL),P=0.32].PHPT-AP also presented with more gastrointestinal symptoms like abdominal pain,nausea,and vomiting with lesser skeletal and renal manifestations as compared to patients with *** AP can be the only presenting feature of *** or higher serum calcium levels during AP should always draw attention towards endocrine causes like PHPT.

关键词： Acute pancreatitis Chronic pancreatitis Parathyroid hormone primary hyperparathyroidism Skeletal manifestations

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primary hyperparathyroidism Revealed by Impaired Renal Function with Persistent Elevation of Parathormon (PTH) and Normal Calcemia after Surgical Removal of the Parathyroid Adenoma

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Open Journal of Endocrine and Metabolic Diseases 2023年第2期13卷 39-44页

作者： Yao Assita Lecadou Jocelyne Maman Salahoudine N’guessan Anselme Danho Jocelyne Kouassi Frank Hué Adélaïde Koffi Dago Pierre Abodo Jacko Endocrinology Diabetology Department CHU Yopougon Abidjan Ivory Coast

Introduction: The curative management of primary hyperparathyroidism is based on surgery. We report the case of a patient presenting with elevated parathormone despite surgical removal of the parathyroid adenoma. Observation: A 48-year-old patient presented for more than 6 months with significant weight loss, polyuria with polydipsia and impaired renal function. The assessment carried out revealed hypercalcaemia at 155 mg/L with hypophastetaemia at 24 mg/L and an elevation of the parathyroid hormone at 218.9 pg/ml. Cervical ultrasound showed a mass at the expense of the lower left parathyroid gland. These results made it possible to conclude primary hyperparathyroidism by parathyroid adenoma which was supported surgically. The postoperative biological assessment revealed a normocalcemia at 85 mg/L associated with an increase in parathormone (PTH) at 271.9 pg/ml. In front of the normalization of calcemia in the subsequent controls and the amendment of all the signs, monitoring was carried out. 9 months after surgery, spontaneous normalization of PTH was observed at 38.4 pg/ml with normal serum calcium at 90 mg/l. Discussion: primary hyperparathyroidism can be revealed by other manifestations. Post-operative follow-up is generally simple with normalization of PTH and serum calcium. However, there may persist an elevation of PTH with normal self-limiting calcemia.

关键词： primary hyperparathyroidism Postoperative Follow-Up Normocalcemic Hyperparathormonemia

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Preoperative serum alkaline phosphatase： a predictive factor for early hypocalcaemia following parathyroidectomy of primary hyperparathyroidism

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Chinese Medical Journal 2014年第18期127卷 3259-3264页

作者： Sun Longhao He Xianghui Liu Tong Department of General Sugery Tianjin Medical University GeneralHospital Tianjin 300052 China

Background Postoperative hypocalcemia is one of the most common complications following parathyroidectomy for primary hyperparathyroidism （PHPT）. The aim of this study was to analyze the predictive value of biochemical parameters as indicators for episodes of hypocalcemia in patients undergoing parathyroidectomy for PHPT. Methods The patients with PHPT who underwent parathyroidectomy between February 2004 and February 2014 were studied retrospectively at a single medical center. The patients were divided into biochemical, clinical, and no postoperative hypocalcemia groups, based on different clinical manifestations, Potential risk factors for postoperative hypocalcemia were identified and investigated by univariate and multivariate Logistic regression analysis. Results Of the 139 cases, 25 patients （18.0%） were diagnosed with postoperative hypocalcemia according to the traditional criterion. Univariate analysis revealed only alkaline phosphatase （ALP） and the small area under the curve （AUG） of receiver operating characteristics （ROC） curve for ALP demonstrates low accuracy in predicting the occurrence of postoperative hypocalcemia. Based on new criteria, 22 patients were added to the postoperative hypocalcemia group and similar biochemical parameters were compared. The serum ALP was a significant independent risk factor for postoperative hypocalcemia （P=0.000） and its AUC of ROC curve was 0.783. The optimal cutoff point was 269 U/L and the sensitivity and specificity for prediction were 89.2% and 64.3%, respectively. Conclusions The risk of postoperative hypocalcemia after parathyroidectomy should be emphasized for patients with typical symptoms of hypocalcemia despite their serum calcium level is in normal or a little higher range. Serum ALP is a predictive factor for the occurrence of postoperative hypocalcemia.

关键词： primary hyperparathyroidism minimally invasive parathyroidectomy postoperative hypocalcemia alkaline phosphatase

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Acute necrotizing pancreatitis as fi rst manifestation of primary hyperparathyroidism

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World Journal of Gastroenterology 2010年第23期16卷 2959-2962页

作者： Jeroen I Lenz Jimmy M Jacobs Bart Op de Beeck Ivan A Huyghe Paul A Pelckmans Tom G Moreels Division of Gastroenterology and Hepatology Antwerp University Hospital Division of Radiology Antwerp University Hospital Division of Nuclear Medicine Antwerp University Hospital

We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid *** the acute pancreatitis was treated *** patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic *** the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity,it is very *** pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known,although some mechanisms have been *** is important to treat the provoking ***,the cause of hypercalcemia should be identif ied *** resection of the parathyroid adenoma is the ultimate therapy.

关键词： Acute necrotizing pancreatitis Hypercalcemia primary hyperparathyroidism Parathyroid adenoma

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The Role of Preoperative Ultrasound and Sestamibi Scintigraphy in the Surgical Management of primary hyperparathyroidism: A Review of Literature

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International Journal of Otolaryngology and Head & Neck Surgery 2022年第2期11卷 91-105页

作者： Daniel Margain Rodrigo Arrangoiz Adrian Legaspi Vanitha Vasudevan Amit Sastry Frank De La Cruz Jeronimo Garcialopez De Llano Jennifer Fernandez Loisani Galindo Noah Llaneras Matthew Farrell Gonzalo Fernandez-Christlieb Fernando Cordera Center for Advanced Surgical Oncology Hialeah FL USA American British Cowdray Medical Center Mexico City Mexico Sociedad Quirurgica S.C. at the American British Cowdray Medical Center Mexico City Mexico

Background: primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases and the most common cause of hypercalcemia. Since routine laboratory testing, the prevalence of the disease has increased from 0.1% to 0.4% worldwide. The only curative treatment is parathyroidectomy. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are cervical ultrasonography (US) and/or Sestamibi scintigraphy. Objectives: To describe the accuracy of US and Sestamibi for detection of hyperfunctioning parathyroid adenomas preoperatively in patients with confirmed pHPT from our medical institution. Results: This is a retrospective study from a prospectively kept database that included thirty-one patients with the confirmed diagnosis of pHPT clinically and biochemically. The average age was 57.8 years old. Preoperative US and surgery findings were compared with a sensitivity of 51%. Preoperative Sestamibi and surgery findings were compared resulting in a sensitivity of 71%. Both imaging methods combined, resulted in a sensitivity of 80%. Conclusion: In patients with pHPT, Sestamibi is an effective method for localizing parathyroid pathology preoperatively, but the false negative rate can be high. US tends to have a wider range explained by the operator-dependent factor. The combination of US and Sestamibi reduces the rate of false negatives, as reported in international literature. It is important to mention that these studies cannot be used as a confirmatory test for this disease. It should only be used as an adjunct to help plan the operation.

关键词： Parathyroid Glands primary hyperparathyroidism Parathyroid Adenoma Parathyroid Hyperplasia Parathyroidectomy Cervical Ultrasound Sestamibi Scintigraphy Limited Neck Exploration

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<sup>11</sup>C-Choline PET/CT in the Management of primary hyperparathyroidism

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International Journal of Otolaryngology and Head & Neck Surgery 2020年第5期9卷 149-160页

作者： Maria R. Alvarez Rodrigo Arrangoiz Miguel Á ngel Olarte Cecilia Carreras Maria M. Leó n S. Fernando Cordera Anahuac University Huixquilucan State of Mexico Mexico Sociedad Quirúrgica S.C. at the American British Cowdray Medical Center Mexico City Mexico American British Cowdray Medical Center Mexico City Mexico Hospital ángeles Lomas Huixquilucan State of Mexico Mexico

primary hyperparathyroidism (PHPT) is a relative common medical problem caused by the inappropriate secretion of parathyroid hormone (PTH) by one or more parathyroid glands. The diagnosis is established by serum calcium and PTH levels and once the diagnosis is established imaging studies help localize the hyperfunctioning adenoma in preparation for curative surgery. Until now, the imaging studies most commonly utilized in PHPT are ultrasonography and 99mTc-Sesta-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy. However, these studies often fail to localize the adenoma and inappropriately delay patient referral to a potentially curative surgery. We present the case of a 64-year-old female with symptomatic PHPT who had 3 negative 99mTc-Sestamibi Scans over a period of 5 years who eventually had a PET/CT with 11C-Choline that identified a right lower parathyroid adenoma. She underwent a right lower parathyroidectomy and had a successful outcome. We present a review the current imaging techniques used in the management of PHPT including 99mTc-Sesta-MIBI scintigraphy and its limitations and novel use of PET/CT with 11C-Choline and 18F-Choline in this disease and emphasize the fact that, according to current guidelines, failure to localize the adenoma should not delay referral for curative surgery.

关键词： primary hyperparathyroidism Evaluation of primary hyperparathyroidism 11C-Choline 18F-Fluorocholine PET/CT Treatment of primary hyperparathyroidism

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Recurrent acute pancreatitis as an initial presentation of primary hyperparathyroidism:A case report

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World Journal of Clinical Cases 2024年第29期12卷 6302-6306页

作者： Masood M Karim Hira Raza Om Parkash Department of Medicine The Aga Khan University HospitalKarachi 74800SindhPakistan Department of Surgery Aga Khan University HospitalKarachi 74800SindhPakistan

BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute *** major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various *** SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary *** cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 *** diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying *** the diagnosis was made,he underwent surgical resection of the *** This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.

关键词： Recurrent pancreatitis primary hyperparathyroidism Normal serum parathyroid hormone Parathyroid adenoma Case report

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