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Parathyroid Storm Secondary to Parathyroid Adenoma Presenting as Acute Necrotizing Pancreatitis

Gupta, Vishal MD, MRCP*; Sunavala, Ayesha J. MD†; Bhansali, Shirish K. MS, FRCS, FACS, FACG, FICS‡; Kakkar, Ritu R. DMRD§

doi: 10.1097/TEN.0b013e3181939504
Case Report

The purpose of this report is to describe a rare case of parathyroid storm secondary to solitary parathyroid adenoma presenting with necrotizing pancreatitis. Parathyroid storm or crisis is seen in approximately 5% of patients with hyperparathyroidism with a double adenoma or carcinoma being the usual causes. Acute pancreatitis is a very rare presentation of hyperparathyroidism ≤1%. Only 20% of acute pancreatitis is necrotizing.

We report a young lady who presented to us with acute onset abdominal symptoms, which were consistent with pancreatitis. She had gallstones and severe hypercalcemia with features of central nervous irritation and nephrogenic diabetes insipidus. The hypercalcemia was parathormone driven which, on imaging, was found to be secondary to a left-sided inferior parathyroid adenoma. It was successfully removed surgically. Although she made a good recovery initially, she later suffered from aspiration pneumonia, ARDS, multiorgan dysfunction, and succumbed to her illness.

Although very rare, severe hypercalcemia should be included in the list of differential diagnosis of patients presenting with pancreatitis. Parathyroid storm with serum calcium up to 25 mg% secondary to single adenoma presenting with necrotizing pancreatitis is very rare with only a few previously described cases in medical literature.

From the *Department of Endocrinology, Diabetes and Metabolic Medicine; Departments of †Endocrinology, ‡General Surgery, and §Radiology, Jaslok Hospital and Research Centre, Mumbai, India.

Reprints: Dr Vishal Gupta, MD, MRCP, 1st floor, flat No. 11, Kshitij Building, 47 Nepean Sea Road, Mumbai 400036, India. E-mail: vishal.drvishgmd@gmail.com.

© 2009 Lippincott Williams & Wilkins, Inc.