Primary hyperparathyroidism can generate recurrent pancreatitis and secondary diabetes mellitus – A case report

Journal of Mind and Medical Sciences Volume 6 | Issue 2 Article 26 2019 Primary hyperparathyroidism can generate recurrent pancreatitis and secondary diabetes mellitus – A case report Nicoleta Mîndrescu Georgeta Văcaru Emil Ștefănescu Loreta Guja Rucsandra Elena Dănciulescu Miulescu Follow this and additional works at: https://scholar.valpo.edu/jmms Part of the Endocrinology, Diabetes, and Metabolism Commons, Gastroenterology Commons, and the Internal Medicine Commons Recommended Citation Mîndrescu, Nicoleta; Văcaru, Georgeta; Ștefănescu, Emil; Guja, Loreta; and Dănciulescu Miulescu, Rucsandra Elena (2019) "Primary hyperparathyroidism can generate recurrent pancreatitis and secondary diabetes mellitus – A case report," Journal of Mind and Medical Sciences: Vol. 6 : Iss. 2 , Article 26. DOI: 10.22543/7674.62.P361366 Available at: https://scholar.valpo.edu/jmms/vol6/iss2/26 This Case Presentation is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at . https://scholar.valpo.edu/jmms/ https://proscholar.org/jmms/ ISSN: 2392-7674 J Mind Med Sci. 2019; 6(2): 361-366 doi: 10.22543/7674.62.P361366 Received for publication: July 06, 2019 Accepted: September 02, 2019 Case report Primary hyperparathyroidism can generate recurrent pancreatitis and secondary diabetes mellitus – A case report Nicoleta Mîndrescu1, Georgeta Văcaru2, Emil Ștefănescu3, Loreta Guja3, Rucsandra Elena Dănciulescu Miulescu3,4 1 Nicodiab Private Practice, Bucharest, Romania EasyDiet Private Practice, Bucharest, Romania 3 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 4 N.C. Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania 2 Abstract Introduction. Acute or recurrent pancreatitis may be a complication of primary hyperparathyroidism and patients with previous episodes of pancreatitis may develop secondary diabetes mellitus. Case report. We describe the clinical case of a 52-year old Caucasian man diagnosed with chronic recurrent pancreatitis in 2007. The first episode of acute pancreatitis occurred in 2002, followed by another 4 episodes in 2004 and 2007. In 2004, papilosfincterectomy was implemented with a stent mount that was removed one month later. In 2005, the patient underwent a surgical intervention for the diagnosis of chronic lithiasis, and cholecystectomy was performed. Additional investigations on the etiology of recurrent chronic pancreatitis, initially diagnosed as idiopathic, revealed elevated values of total serum calcium, serum parathormone, and the presence of a parathyroid adenoma in the right lower pole of the thyroid. In September 2007, parathyroidectomy was performed with a favorable evolution and the remission of the acute pancreatitis episodes. The patient had not had any family history of diabetes; in 2017 he was diagnosed with diabetes. Conclusion. In cases of recurrent pancreatitis, screening for hyperparathyroidism is recommended. Metabolic evaluation is required, because the risk of developing diabetes in patients with recurrent pancreatitis is high. Keywords  Highlights ✓ In cases of recurrent renal lithiasis or pancreatitis, screening for hyperparathyroidism is recommended. primary hyperparathyroidism, recurrent pancreatitis, secondary diabetes mellitus ✓ Metabolic evaluation is required in patients with recurrent pancreatitis because of their high risk of developing diabetes. To cite this article: Nicoleta Mîndrescu, Georgeta Văcaru, Emil Ștefănescu, Loreta Guja, Rucsandra Elena Dănciulescu Miulescu. Primary hyperparathyroidism can generate recurrent pancreatitis and secondary diabetes mellitus – A case report. J Mind Med Sci. 2019; 6(2): 361-366. DOI: 10.22543/7674.62.P361366 *Corresponding author: Rucsandra Elena Dănciulescu Miulescu, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania E-mail: Nicoleta Mîndrescu et al. Introduction Primary hyperparathyroidism is an endocrine disorder generated by the autonomous production of parathyroid hormone (PTH). The prevalence of the disease varies between 0.1% and 1.0 %, being the third endocrine disease after diabetes and thyroid disorder. The affliction is generated in most situations by a solitary parathyroid adenoma. Other causes of primary hyperparathyroidism include: multiple adenoma, hyperplasia of the four glands, and parathyroid carcinoma (1). PTH acts on the bones, kidneys, and small intestine. In the bones, PTH stimulates osteoblasts directly and osteoclasts indirectly, which leads to the release of calcium secondary to the resorption of the bones. The effects of PTH on the kidneys include: increased calcium reabsorption and decreased phosphate reabsorption; and activation of the 1 α hydroxylase, an enzyme that catalyzes the transformation of 25hydroxycholecalciferol (the inactive form of vitamin D) to 1,25-dihydroxycholecalciferol (the active form of vitamin D). In the small intestine, the active form of vitamin D ensures the absorption of calcium through two pathways: active transcellular and passive paracellular pathway (2, 3). The consequences of primary hyperparathyroidism are hypercalcemia (but the normocalcemic variant is now recognized), hypercalciuria, hypophosphatemia, damage of the cortical and trabecular bones, renal, gastrointestinal, cardiovascular, neuromuscular, and psychiatric symptoms. The clinical form includes symptomatic or asymptomatic diseases. Symptomatic primary hyperparathyroidism occurs in countries where biochemical screenings are not routinely used (4). The introduction of the serum AutoAnalyzer in 1970 allowed the identification of patients with asymptomatic hypercalcemia, and advances in techniques to determine PTH have facilitated the diagnosis of primary hyperparathyroidism (5). Acute or recurrent pancreatitis may be a complication of primary hyperparathyroidism (6, 7). The prevalence of acute or recurrent pancreatitis in patients with primary hyperparathyroidism has been estimated, according to some studies, between 1.5% and 13% (5). A study published in 2009 by Khoo and collaborators contradicts previous reports. Their study included 684 patients with primary hyperparathyroidism. 10 patients (1.5%) developed acute pancreatitis compared to 32 out of the 1,368 (2.3%) from the control group. The authors concluded that there is no causal relationship between primary hyperparathyroidism and acute pancreatitis (8). Subjects with previous episodes of pancreatitis may develop diabetes mellitus. The prevalence of diabetes secondary to pancreatitis is estimated between 5% and 10% 362 in the Western population (9, 10). In 2013, Ewald and Bretzel suggested several diagnostic criteria for diabetes mellitus secondary to pancreatic diseases, as follows: “ 1) the presence of pancreatic exocrine insuffici (...truncated)