DOES SUBCLINICAL PANCREATIC INFLAMMATION OCCUR AFTER PARATHYROIDECTOMY

Pancreatitis is accepted as an uncommon complication of parathyroid su rgery, but it has been suggested that up to 35% of patients may experi ence hyperamylasaemia after parathyroidectomy indicating subclinical i nflammation of the pancreas. A series of 26 patients undergoing parath yroidectomy were studied by preoperative biochemical analyses repeated 24 and 48 h postoperatively allowing changes in calcium metabolism an d serum and urinary amylase levels to be documented. Of the patients, 21 also underwent a CT scan of the pancreas between 24 and 48 h after operation. Despite highly significant changes in serum parathormone, c alcium and phosphate levels postoperatively, there was no evidence in any patient of acute pancreatic inflammation or hyperamylasaemia. Twen ty-one patients underwent unilateral neck exploration, and we suggest that the absence of any detectable amylase elevation supports the sugg estion that such elevation may reflect an increase in salivary isoamyl ase as a result of extensive neck dissection, rather than reflecting a subclinical pancreatitis. The development of postparathyroidectomy pa ncreatitis appears to be an all or nothing phenomenon of unknown aetio logy.