This is a 54-year-old patient, whose personal history only highlighted that she had undergone cholecystectomy in childhood and had been admitted several years ago for community-acquired pneumonia.
He smoked 10 cigarettes a day, had no other toxic habits and did not follow any chronic treatment.
She had recurrent abdominal pain, which had meant three hospital admissions with high levels of amylase and diagnosis of acute pancreatitis, without reaching an etiological diagnosis.
Therefore, a study was being conducted in gastroenterology clinics.
During this follow-up, several analytical tests were performed in which serum calcium levels were around the upper limits of normal (considering normal ranges of serum calcium between 8.4-10.4 mg/dl), without being pathological in any case.
It is noteworthy that in previous admissions for pancreatitis, calcium levels were always normal.
She was admitted again due to abdominal pain, located in the epigastrium and irradiating to both hypochondria.
The pain was continuous and limited its intake.
Analytically he stood out at his reception:
-Hb: 13.8 g/dl; hematocrit: 40%; leukocytes: 13400 (81% neutrophils).
Seizure: 99 mg/dl; urea: 33 mg/dl; creatinine: 1.03 mg/dl.
Plasma amylase: 1980 U/l; lipase: 630 U/l.
Cholesterols: 210 mg/dl; triglycerides: 98 mg/dl.
-Proteins: 7.1 g/dl; albumin: 4.5 g/dl.
Calcium: 1 mg/dl; acid 6.9 mg/dl.
With the diagnosis of acute pancreatitis an abdominal ultrasound is performed first, and an echoendoscopy later, in which there is no evidence of stones, microlithiasis or mud in the bile duct.
Abdominal CT showed an edematous and destructured pancreas, with no further findings.
The negativity of the examinations regarding the etiology of pancreatitis was postulated as a possible relationship of the same with the hypercalcemia objectified in the routine analytical of the patient at admission.
Thus, a new determination of plasma calcium and intact parathyroid hormone (iPTH) was performed, whose values were respectively 11.9 mg/dl and 451 pg/ml (normal values below 9 pg/ml).
The patient presented favorable evolution of his pancreatitis on the following days, with normalization of amylase and lipase levels, obtaining a correct oral tolerance and disappearance of pain.
When the clinical picture was completely resolved, a Tc99-Sestamibi scintigraphy showed uptake compatible with right inferior parathyroid adenoma.
Days later the patient was operated on, finding the lesion and removing it.
The decrease in iPTH levels was verified intraoperatively.
Pathology of the specimen confirmed that it was a parathyroid adenoma.
After this episode, the patient reported no more episodes of abdominal pain in subsequent reviews.
