Parathyroid carcinoma presenting as severe necrotising pancreatitis: early recognition and cure

Abstract

Parathyroid carcinoma (PC) is rare and typically presents with severe hypercalcemia. Acute pancreatitis as the initial manifestation is uncommon and may delay diagnosis. A 50-year-old lady with no comorbidities presented to the medical Gastroenterology Department with acute severe necrotising pancreatitis (CTSI 9, BISAP 2), complicated by multiorgan dysfunction. Laboratory evaluation revealed marked hypercalcemia (corrected calcium 12.3–11.3 mg/dl), hypophosphatemia (1.5 mg/dl), and a significantly elevated parathyroid hormone (PTH) level (217 pg/ml). No gallstones were identified on imaging. Further localisation with neck ultrasound and sestamibi scan highlighted a right superior parathyroid lesion. Following optimisation, the lesion was excised. Intraoperative PTH fell to 9.7 pg/ml at 30 minutes postoperatively and serum calcium normalised (POD1 9.9 mg/dl, POD2 8.4 mg/dl). Histopathology confirmed parathyroid carcinoma (25×20×15 mm) with capsular and vascular invasion. In severe or “idiopathic” pancreatitis, concurrent hypercalcemia with elevated PTH should prompt evaluation for primary hyperparathyroidism, including rare parathyroid carcinoma. Timely surgery can be curative; vigilant postoperative surveillance is essential.