ESPE Abstracts

Introduction: Acute pancreatitis (AP) is rarely seen in children and is typically not associated with common aetiologies seen in adults. AP secondary to hypercalcaemia due to primary hyperparathyroidism (PHPT) is very rare. The annual incidence of PHPT in adults is 30/100,000 with female predominance and 2–5/100,000 in children regardless of sex. We present a rare presentation of PHPT presenting with AP in a 12-year-old boy.

Case discussion: 12-year-old boy presented with acute abdominal pain with biochemical evidence of elevated serum amylase, calcium, ALP and parathyroid hormone (PTH) levels with elevated urinary calcium creatinine ratio. USS showed features of AP. Diagnosis of AP was made, which was settled with conservative management. Hypercalcaemia was managed with IV fluids, hyper hydration and frusemide in acute stage. Since he had persistent hypercalcaemia, he was started on cinacalcet 15mg twice daily. His vitamin D was low and treated with cholecalciferol. He didn’t have other symptoms of hypercalcaemia such as bone pain, polyuria, polydipsia, weight loss or symptoms suggestive of urolithiasis or nephrolithiasis. Clinically he was euthyroid with normal thyroid function. There was no family history of renal calculi, hypercalcemia, thyroid or other endocrine neoplasms. His prolactin and IGF1 was normal and he didn’t have episodes of hypoglycaemia. Further investigations, namely CT and technetium 99m (Tc-99m) sestamibi scans, revealed a solitary lesion at left superior pole suggestive of parathyroid adenoma measuring 13×4×5 mm and thyroid gland was normal with no focal lesions. He subsequently underwent minimally invasive parathyroidectomy. Intraoperatively PTH dropped from 178.5pg/ml to 24.9pg/ml. Ca and PTH levels normalized postoperatively. Histology revealed a parathyroid adenoma.

Discussion: PHPT in children presents with hypercalcaemic symptoms such as bone pain, urolithiasis, nephrolithiasis, or nonspecific symptoms like fatigue and muscle weakness. However, adults are mostly asymptomatic and detected during routine laboratory testing. Solitary benign sporadic parathyroid adenoma is the most common cause of PHPT in the general population, including children and adolescents. PHPT is often associated with rare genetic disorders such as multiple endocrine neoplasia 1 and 2A. In the absence of genetic testing long term surveillance and follow up is needed for these children. Intraoperative PTH monitoring is an important investigation to confirm the success of the surgery and to plan further surgical interventions.