Pancreatitis due to hypercalcaemia

Pancreatitis associated with hypercalcaemia occurs chiefly in hyperparathyroidism. Incidence of hyperparathyroidism in association with primary pancreatitis ranges between 1.5% and 7%. This can reach 25% in cases of acute hyperparathyroidism. This variability is due to the association with other potential causes, such as chronic alcoholism or gallstones, coexisting in almost 60% of cases. Pancreatitis affects males more often than females (54 %), whereas hyperparathyroidism is markedly more common in women. In the majority of cases, pancreatitis reveals hyperparathyroidism. The parathyroid lesion is adenoma in 70 - 80 % of cases, and hyperplasia (10 %) or cancer (10 %).

All types of pancreatitis can occur. Chronic calcifying pancreatitis is the most frequent (40% of cases). Some of this pancreatitis is clinically latent, with calcifications being discovered during the assessment of hyperparathyroidism. Most cases are symptomatic, painful, and indicative of hyperparathyroidism. Acute inaugural pancreatitis occurs in 1/3 of cases, and recurs in 12% of cases. The clinical signs are unremarkable: abdominal pain occurs in 2 out of 3 cases. The presence of bone (25%) or kidney (urolithiasis: 40%) abnormalities should suggest hyperparathyroidism.

How is the diagnosis made?

Biological diagnosis is based on determination of the calcium serum level, which is constantly high. In the subclinical or emerging forms, alternating hyper-/normocalcaemia could be observed.

Cases of pancreatitis due to hypercalcaemia without hyperparathyroidism have been reported: paraneoplastic syndromes of breast and kidney cancer, myeloma, leiomyosarcoma, acute T cell leukaemia, total parenteral nutrition, parenteral administration of calcium, hypervitaminosis D...

The exact mechanism of pancreatitis is completely unknown.

What are the treatment options?

Pancreatitis due to hyperparathyroidism should be treated by ablation of the hormone-secreting lesion. Rapid parathyroidectomy allows complete regression of clinical and laboratory signs in pancreatitis.