Unique Case of Month: February 2024
A rear case of a 17 year old male patient admitted with complaints of severe abdominal pain with the history of hospitalisation two times in the past 3 months for acute Pancreatitis.

Patient investigated in details found to have hypercalcemia and raised Parathyroid Hormone levels .

The USG neck was done showing the Paratracheal lymph node.

For confirmation Sestamibi scan was done which revealed left lower lobe parathyroid adenoma.

Hence the call for Minimal Invasive Excision of Parathyroid adenoma was taken.

The patient underwent Minimal Invasive Parathyroidectomy (MIP) with 2.5 cm incision. Intraoperative USG done for localisation. Intraoperative frozen section confirmation done. Intraoperative blood samples sent for PTH levels at 5 minutes and 15 minutes which showed fallen values of 93.9 and 51.9 respectively from preoperative values of 326. Post operative patient parathyroid level back to normal level.

Primary Hyperparathyroidism Masquerading as Recurrent Pancreatitis in a 17-Year-Old Male

Case Presentation

A 17-year-old male presented with severe epigastric pain and a history of two hospitalizations for acute pancreatitis within the past 3 months. Despite conservative management, symptoms recurred, prompting further evaluation.

Diagnostic Workup

• Laboratory Findings:

  • Persistent hypercalcemia (corrected calcium: 12.8 mg/dL).

  • Elevated parathyroid hormone (PTH) level: 326 pg/mL (normal: 15–65 pg/mL).

• Imaging:

  • Ultrasound neck: Revealed a paratracheal hypoechoic nodule (suggestive of parathyroid pathology).

  • Sestamibi scan: Confirmed a left inferior parathyroid adenoma.

Management

• Minimally Invasive Parathyroidectomy (MIP) was performed via a 2.5 cm targeted incision.

• Intraoperative Protocol:

  • Ultrasound-guided localization.

  • Frozen section confirmation of adenoma.

  • Serial PTH monitoring: Post-excision levels dropped to 93.9 pg/mL (5 min) and 51.9 pg/mL (15 min), confirming biochemical cure.

Outcome

• Postoperative PTH and calcium levels normalized.

• No recurrence of pancreatitis or hypercalcemia at follow-up.

Key Learning Points

1. Hyperparathyroidism, though rare in adolescents, should be considered in recurrent pancreatitis with hypercalcemia.

2. Sestamibi scan remains gold-standard for preoperative localization.

3. MIP with intraoperative PTH monitoring ensures high success rates with minimal morbidity.

Takeaway: This case highlights the importance of investigating secondary causes of pancreatitis, particularly in young patients with atypical presentations.