Gastric Outlet Obstruction following Recurrent Pancreatitis Uncovers A Giant Parathyroid Adenoma
A Case Report
DOI:
https://doi.org/10.15605/jafes.037.01.11Keywords:
Giant parathyroid adenoma, pancreatitis, gastric outlet obstruction, primary hyperparathyroidismAbstract
A 35-year-old female presented with abdominal pain, fever, projectile vomiting, and a diffuse tender epigastric mass. She was diagnosed to have acute persistent pancreatitis with a pancreatic pseudocyst. Elevated serum calcium levels provided an etiologic link between hypercalcemia and pancreatitis. On examination, a nodule was found in the left side of her neck which was later diagnosed as a giant left inferior parathyroid adenoma. This report highlights the critical analysis of history, examination, and investigations to reach an ultimate diagnosis. Pseudocyst drainage and parathyroidectomy resolved her symptoms.
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Sunkara T, Caughey ME, Rawla P, Yarlagadda KS, Gaduputi V. Severe acute pancreatitis as an index clinical manifestation of parathyroid adenoma. Cureus. 2018;10(4):e2445. https://pubmed.ncbi.nlm.nih.gov/29888149. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991921. https://doi.org/10.7759/cureus.2445.
Aslam M, Talukdar R, Jagtap N, et al. Clinical profile and outcome of parathyroid adenoma-associated pancreatitis. Saudi J Med Med Sci. 2018;6(2):95-9. https://pubmed.ncbi.nlm.nih.gov/30787828. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196711. https://doi.org/ 10.4103/sjmms.sjmms_80_17.
Rubin MR, Bilezikian JP, McMahon DJ, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008;93(9):3462-70. https://pubmed.ncbi.nlm.nih.gov/18544625. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567863. https://doi.org/10.1210/jc.2007-1215.
Jha S, Jayaraman M, Jha A, Jha R, Modi KD, Kelwadee JV. Primary hyperparathyroidism: A changing scenario in India. Indian J Endocrinol Metab. 2016;20(1):80-3. https://pubmed.ncbi.nlm.nih.gov/26904473. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743389. https://doi.org/ 10.4103/2230-8210.172237.
Krishnamurthy A, Raghunandan GC, Ramshankar V. A rare case of giant parathyroid adenoma presenting with recurrent episodes of pancreatitis. Indian J Nucl Med. 2016;31(1):36-8. https://pubmed.ncbi.nlm.nih.gov/26917892. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746839. https://doi.org/10.4103/0972-3919.172355.
Al-Hassan MS, Mekhaimar M, El Ansari W, Darweesh A, Abdelaal A. Giant parathyroid adenoma: A case report and review of the literature. J Med Case Rep. 2019;13(1):332. https://pubmed.ncbi.nlm.nih.gov/31722742. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854700. https://doi.org/10.1186/s13256-019-2257-7.
Spanheimer PM, Stoltze AJ, Howe JR, Sugg SL, Lal G, Weigel RJ. Do giant parathyroid adenomas represent a distinct clinical entity? Surgery. 2013;154(4):714-8. https://pubmed.ncbi.nlm.nih.gov/23978594. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787983. https://doi.org/10.1016/j.surg.2013.05.013.
Garas G, Poulasouchidou M, Dimoulas A, Hytiroglou P, Kita M, Zacharakis E. Radiological considerations and surgical planning in the treatment of giant parathyroid adenomas. Ann R Coll Surg Engl. 2015;97(4):e64-6. https://pubmed.ncbi.nlm.nih.gov/26263956. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473887. https://doi.org/10.1308/003588415X14181254789682.
Mantzoros I, Kyriakidou D, Galanos-Demiris K, et al. A rare case of primary hyperparathyroidism caused by a giant solitary parathyroid adenoma. Am J Case Rep. 2018;19:1334-7. https://pubmed.ncbi.nlm.nih.gov/30405093. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238585. https://doi.org/ 10.12659/AJCR.911452.
Kelly KJ, Chen H, Sippel RS. Primary hyperparathyroidism. Cancer Treat Res. 2010;153:87-103. https://pubmed.ncbi.nlm.nih.gov/19957221. https://doi.org/10.1007/978-1-4419-0857-5_6.
Bai HX, Giefer M, Patel M, Orabi AI, Husain SZ. The association of primary hyperparathyroidism with pancreatitis. J Clin Gastroenterol. 2012;46(8):656-61. https://pubmed.ncbi.nlm.nih.gov/22874807. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428665. https://doi.org/10.1097/MCG.0b013e31825c446c.
Arya AK, Bhadada SK, Mukherjee S, et al. Frequency & predictors of pancreatitis in symptomatic primary hyperparathyroidism. Indian J Med Res. 2018;148(6):721-7. https://pubmed.ncbi.nlm.nih.gov/30778006. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396558. https://doi.org/10.4103/ijmr.IJMR_353_16.
Carnaille B, Oudar C, Pattou F, Combemale F, Rocha J, Proye C. Pancreatitis and primary hyperparathyroidism: Forty cases. Aust N Z J Surg. 1998;68(2):117-9. https://pubmed.ncbi.nlm.nih.gov/9494002. https://doi.org/10.1111/j.1445-2197.1998.tb04719.x.
Felderbauer P, Karakas E, Fendrich V, Lebert R, Bartsch DK, Bulut K. Multifactorial genesis of pancreatitis in primary hyperparathyroidism: evidence for “protective” (PRSS2) and “destructive” (CTRC) genetic factors. Exp Clin Endocrinol Diabetes. 2011;119(1):26–9. https://pubmed.ncbi.nlm.nih.gov/20625975. https://doi.org/10.1055/s-0030-1255106.
Imrie CW, Buist LJ, Shearer MG. Importance of cause in the outcome of pancreatic pseudocysts. Am J Surg. 1988;156 (3 Pt 1):159-62. https://pubmed.ncbi.nlm.nih.gov/2458684. https://doi.org/10.1016/s0002-9610(88)80055-2.
Boerma D, Obertop H, Gouma DJ. Pancreatic pseudocysts in chronic pancreatitis. Surgical or interventional drainage? Ann Ital Chir. 2000;71(1):43-50. https://pubmed.ncbi.nlm.nih.gov/10829523.
Gouyon B, Lévy P, Ruszniewski P, et al. Predictive factors in the outcome of pseudocysts complicating alcoholic chronic pancreatitis. Gut. 1997;41(6):821-5. https://pubmed.ncbi.nlm.nih.gov/9462217. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1891603. https://doi.org/10.1136/gut.41.6.821.
Zhang Y, Zhang SY, Gao SL, Liang ZY, Yu WQ, Liang TB. Successful resolution of gastric outlet obstruction caused by pancreatic pseudocyst or walled-off necrosis after acute pancreatitis: The role of percutaneous catheter drainage. Pancreas. 2015;44(8):1290-5. https://pubmed.ncbi.nlm.nih.gov/26465954. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947542. https://doi.org/10.1097/MPA.0000000000000429.
Aranha GV, Prinz RA, Greenlee HB, Freeark RJ. Gastric outlet and duodenal obstruction from inflammatory pancreatic disease. Arch Surg. 1984;119(7):833–5. https://doi.org/10.1001/archsurg.1984.01390190071016.
Agalianos C, Passas I, Sideris I, Davides D, Dervenis C. Review of management options for pancreatic pseudocysts. Transl Gastroenterol Hepatol. 2018;3:18. https://pubmed.ncbi.nlm.nih.gov/29682625. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897675. https://doi.org/10.21037/tgh.2018.03.03.
Borumandi F, Daultrey H, Laji K, Bosman D, Ashford N, Alam P. Detectability and surgical outcomes in parathyroid surgery - a single-centre experience. Br J Oral Maxillofac Surg. 2019;57(4):330-5. https://pubmed.ncbi.nlm.nih.gov/30930031. https://doi.org/10.1016/j.bjoms.2019.03.007.
Lezaic L, Rep S, Sever MJ, Kocjan T, Hocevar M, Fettich J. ¹⁸F-Fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study. Eur J Nucl Med Mol Imaging. 2014s;41(11):2083-9. https://pubmed.ncbi.nlm.nih.gov/25063039. https://doi.org/10.1007/s00259-014-2837-0.
Prabhu M, Damle NA. Fluorocholine PET imaging of parathyroid disease. Indian J Endocrinol Metab. 2018;22(4):535-41. https://pubmed.ncbi.nlm.nih.gov/30148104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085954. https://doi.org/10.4103/ijem.IJEM_707_17.
Witteveen JE, van Thiel S, Romijn JA, Hamdy NA. Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: A systematic review of the literature. Eur J Endocrinol. 2013;168(3):R45-53. https://pubmed.ncbi.nlm.nih.gov/23152439. https://doi.org/10.1530/EJE-12-0528.
Misgar RA, 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;15(1):54-6. https://pubmed.ncbi.nlm.nih.gov/21584170. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079873. https://doi.org/10.4103/2230-8210.77588.
Vera C, Díez M, San Román R, Ratia T, Granell J. Primary hyperparathyroidism and acute pancreatitis. Endocrinol Nutr. 2013;60(5):275–6. https://pubmed.ncbi.nlm.nih.gov/23332718, https://doi.org/10.1016/j.endoen.2012.05.005.
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