Primary hyperparathyroidism as a cause of calcific pancreatitis and diabetes mellitus in a young woman


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Abstract

Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder. The manifest form still prevails in Russia; its classic clinical presentation involves bone, kidney, and gastrointestinal disturbance. Calcific pancreatitis associated with diabetes is a rare PHPT presentation. The case demonstrates the late diagnosis of PHPT, against the background of long-term unrecognized classic manifestations of PHPT, that included fibrocystic osteitis, as well as a nonclassical manifestation - calcific pancreatitis, that led to diabetes mellitus. Being undiagnosed and untreated for a long time, the disease developed severe complications both in a patient (fibrocystic osteitis, preterm labor, calcific pancreatitis, diabetes mellitus) and in a newborn (hypocalcemic seizures). After a parathyroidectomy was performed, the partial regression of bone changes was observed. Despite chronic calcific pancreatitis associated with diabetes being a rare manifestation of primary hyperparathyroidism, clinical symptoms of PHPT, and a history of chronic pancreatitis with repeated episodes of acute pancreatitis, should keep a high index of suspicion for hypercalcemia as a cause of pancreas damage.

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About the authors

K. A Pogosyan

National Medical Research Centre named after V.A. Almazov of the Ministry of Healthcare of Russia

Email: karina.a.pogosyan@gmail.com
194021, Saint Petersburg, 15 Parkhomenko Avenue. Tel.: +7 (921) 424-93-32

X. L Karonova

National Medical Research Centre named after V.A. Almazov of the Ministry of Healthcare of Russia; Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia

Email: karonova@mail.ru
194021, Saint Petersburg, 15 Parkhomenko Avenue. Tel.: +7 (921) 310-60-41

L. G Yanevskaya

National Medical Research Centre named after V.A. Almazov of the Ministry of Healthcare of Russia

Email: fosterthefire@yandex.ru
194021, Saint Petersburg, 15 Parkhomenko Avenue

A. T Andreeva

National Medical Research Centre named after V.A. Almazov of the Ministry of Healthcare of Russia

Email: arabicaa@gmail.com
194021, Saint Petersburg, 15 Parkhomenko Avenue

D. V Ryzhkova

National Medical Research Centre named after V.A. Almazov of the Ministry of Healthcare of Russia

Email: d_ryjkova@mail.ru
197341, Saint Petersburg, 2 Akkuratova Str

L. V Belousova

National Medical Research Centre named after V.A. Almazov of the Ministry of Healthcare of Russia

194021, Saint Petersburg, 15 Parkhomenko Avenue

U. A Tsoi

National Medical Research Centre named after V.A. Almazov of the Ministry of Healthcare of Russia

194021, Saint Petersburg, 15 Parkhomenko Avenue

E. N Grineva

National Medical Research Centre named after V.A. Almazov of the Ministry of Healthcare of Russia

Email: grineva_e@mail.ru
194021, Saint Petersburg, 15 Parkhomenko Avenue

References

  1. Melton L.J. 3rd. The epidemiology of primary hyperparathyroidism in North America. J Bone Miner Res. 2002; 17 Suppl 2: N12-17.
  2. Yanevskaya L.G., Karonova T.L., Sleptsov I.V. et al. Clinical phenotypes of primary hyperparathyroidism in hospitalized patients who underwent parathyroidectomy. Endocrine Connections. 2021; 10(2): 248-55. doi: 10.1 530/EC-20-051 5.
  3. Bilezikian J.P., Cusano N.E., Khan A.A. et al. Primary hyperparathyroidism. Nat Rev Dis Primers. 2016; 2: 16033. doi: 10.1038/ nrdp.2016.33.
  4. Bilezikian J.P. Primary hyperparathyroidism. J Clin Endocrinol Metab. 2018; 103(11): 3993-4004. doi: 10.1210/jc.2018-01225.
  5. Дедов И.И., Мельниченко Г.А., Мокрышева Н.Г. с соавт. Первичный гиперпаратиреоз: клиника, диагностика, дифференциальная диагностика, методы лечения. Проблемы эндокринологии. 2016; 6: 40-77. @@Dedov I.I., Melnichenko G.A., Mokrysheva N.G. et al. Primary hyperparathyroidism: the clinical picture, diagnostics, differential diagnostics, and methods of treatment. Problemy endokrinologii = Problems of Endocrinology. 2016; 6: 40-77. (In Russ.). doi: https://doi.org/10.14341/probl201662640-77.
  6. Khoo T.K., Vege S.S., Abu-Lebdeh H.S. et al. Acute pancreatitis in primary hyperparathyroidism: a population-based study. J Clin Endocrinol Metab. 2009; 94(6): 2115-18. doi: 10.1210/jc.2008-1965.
  7. Walker M.D., Silverberg S.J. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018; 14(2): 115-25. doi: 10.1038/nrendo.2017.104.
  8. Misgar R.A., Mathew V., Pandit K., Chowdhury S. Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature. Indian J Endocrinol Metab. 2011; 1 5(1): 54-56. doi: 10.4103/2230-8210.77588.
  9. Taylor W.H., Khaleeli A.A. Coincident diabetes mellitus and primary hyperparathyroidism. Diabetes Metab Res Rev. 2001; 17(3): 175-80. doi: 10.1002/dmrr.199.
  10. Rajput R., Mittal A., Singh J. et al. Recurrent diabetic ketoacidosis: a rare presenting manifestation of primary hyperparathyroidism. Clin Cases Miner Bone Metab. 2016; 13(3): 262-64. doi: 10.11138/ccmbm/2016.13.3.262.
  11. Cope O., Culver P.J., Mixter C.G. Jr, Nardi G.L. Pancreatitis, a diagnostic clue to hyperparathyroidism. Ann Surg. 1957; 145(6): 857-63. doi: 10.1097/00000658-195706000-00007.
  12. Sitges-Serra A., Alonso M., de Lecea C. et al. Pancreatitis and hyperparathyroidism. Br J Surg. 1988; 75(2): 158-60. doi: 10.1002/bjs.1800750224.
  13. Shearer M.G., Imrie C.W. Parathyroid hormone levels, hyperparathyroidism and acute pancreatitis. Br J Surg. 1986; 73(4): 282-84. doi: 10.1002/bjs.1800730412.
  14. Carnaille B., Oudar C., Pattou F. et al. Pancreatitis and primary hyperparathyroidism: forty cases. Aust N Z J Surg. 1998; 68(2): 117-19. doi: 10.1111/j.1445-2197.1998.tb04719.x.
  15. Mithofer K., Fernandez-del Castillo C., Frick T.W. et al. Acute hypercalcemia causes acute pancreatitis and ectopic trypsinogen activation in the rat. Gastroenterology. 1995; 109(1): 239-46. doi: 10.1016/0016-5085(95)90290-2.
  16. Kelly T.R. Relationship of hyperparathyroidism to pancreatitis. Arch Surg. 1968; 97(2): 267-74. doi: 10.1001/ archsurg.1968.01340020131016.
  17. Lenz J.I., Jacobs J.M., Op de Beeck B. et al. Acute necrotizing pancreatitis as first manifestation of primary hyperparathyroidism. World J Gastroenterol. 2010; 16(23): 2959-62. doi: 10.3748/wjg.v16.i23.2959.
  18. Felderbauer P., Karakas E., Fendrich V. et al. Pancreatitis risk in primary hyperparathyroidism: relation to mutations in the SPINK1 trypsin inhibitor (N34S) and the cystic fibrosis gene. Am J Gastroenterol. 2008; 103(2): 368-74. doi: 10.1111/j.1572-0241.2007.01695.x.
  19. Dochez V., Ducarme G. Primary hyperparathyroidism during pregnancy. Arch Gynecol Obstet. 2015; 291(2): 259-63. doi: 10.1007/s00404-014-3526-8.
  20. Gallo D., Rosetti S., Marcon I. et al. When primary hyperparathyroidism comes as good news. Endocrinol Diabetes Metab Case Rep. 2020; 2020: 20-0046. doi: 10.1530/EDM-20-0046. Online ahead of print.
  21. Mackenzie-Feder J., Sirrs S., Anderson D. et al. Primary hyperparathyroidism: an overview. Int J Endocrinol. 2011; 2011: 251410. doi: 10.1 155/201 1/251410.
  22. Wang X.M., Wu Y.W., Li Z.J. et al. Polymorphisms of CASR gene increase the risk of primary hyperparathyroidism. J Endocrinol Invest. 2016; 39(6): 617-25. doi: 10.1007/s40618-015-0405-5.
  23. Available at: https://www.ncbi.nlm.nih.gov/clinvar/variation/459175/(date of access - 1 1.05.2021).
  24. Richards S., Aziz N., Bale S. et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med. 2015; 17(5): 405-24. doi: 10.1038/gim.2015.30.

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