HYPERPARATHYROIDISM PRESENTING AS PANCREATITIS OR COMPLICATED BY POSTOPERATIVE PANCREATITIS

Background: The association of hyperparathyroidism with acute pancreat itis either pre-operatively or postoperatively has been questioned in recent overseas literature. Methods: A review of medical records and h istology reports in the Royal Hobart Hospital from 1971 to 1993 was ca rried out to identify all cases of acute pancreatitis associated with primary hyperparathyroidism. Results: Seven cases are presented, six w ith histological confirmation, of hyperparathyroidism associated with pancreatitis in a period when 137 confirmed cases of primary hyperpara thyroidism were treated. None of these patients had gallstones. In two , alcohol abuse may have been the aetiological factor. Five patients h ad successful neck exploration and none of them have experienced any f urther attacks including a 25 year old who had four hospitalizations a nd one laparotomy for pancreatitis in the year before parathyroidectom y 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 wo uld proceed to mediastinotomy, if necessary, at initial exploration in a patient with previous hypercalcaemic crisis. This should also be co nsidered in patients with a history of acute pancreatitis.