Recurrent Acute Pancreatitis Secondary to Untreated Hyperparathyroidism: A Case Report and Literature Review.

Acute pancreatitis (AP) is a common gastrointestinal disease with diverse etiologies, among which hyperparathyroidism represents a rare but well-established cause. While a single episode of AP can often be managed supportively, failure to definitively treat the underlying hyperparathyroidism significantly increases the risk of recurrence. We present the case of a 63-year-old woman admitted for moderate AP with documented hypercalcemia (total calcium 11.11 mg/dL). She was subsequently referred to endocrinology, where parathyroid hormone (PTH) was found to be 238 pg/mL, and parathyroid scintigraphy with 99mTc-sestamibi showed equivocal focal uptake at the upper pole of the right thyroid lobe, consistent with a possible right superior parathyroid adenoma. Despite confirmed biochemical hyperparathyroidism and a recent history of AP, the clinical recommendation was watchful waiting, with follow-up at three months, without surgical referral. Three years later, at the age of 66, she was re-admitted with a second episode of mild AP. PTH had risen to 777.5 pg/mL with total calcium 12.12 mg/dL, supporting hyperparathyroidism as the likely underlying etiology. Given the patient's underlying chronic kidney disease, tertiary hyperparathyroidism could not be excluded, although the patient's relatively stable renal function favored primary hyperparathyroidism. This case highlights two important clinical lessons for the management of hyperparathyroidism-associated pancreatitis. First, it is essential to routinely assess serum calcium and PTH levels in all patients with AP of unknown origin. Second, the decision to perform a parathyroidectomy should be based on clinical and biochemical evidence and should not be postponed due to inconclusive imaging results. A review of the current literature emphasizes that parathyroidectomy is the only definitive treatment for symptomatic hyperparathyroidism. Early detection, prompt surgical referral, and effective communication with patients are vital for preventing recurrence in this manageable condition.