We present the clinical case of a patient who developed acute
hypercalcemia diagnosed after presenting
acute pancreatitis.Male patient, age 67, arrived at the Emergency Department of the University Hospital of Parma for upper
abdominal pain, radiated to the back, and associated with
nausea. Laboratory tests showed elevation of
lipase, serum
calcium levels, PTH levels and serum
creatinine. Due to the persistence on
hypercalcemia an ultrasound scan of the cervical region was performed and showed a hyperechoic nodule of about 25x26x30 mm at the level of the lower pole of the left thyroid lobe, compatible with hyperplastic parathyroid. In the light of clinical-radiological examinations,
acute edematous pancreatitis due to
hypercalcemia was diagnosed.
Hypercalcemia was attributable to
primary hyperparathyroidism, so surgical indication to
parathyroidectomy was gave.After medical treatment there was a progressive improvement of the clinical conditions and a few days later the patient underwent surgical operation of lower left
parathyroidectomy with progressive normalization of the serum
calcium levels. If
hypercalcemia persists after the beginning of a specific
therapy there is an indication to perform an emergency
parathyroidectomy; in our case the
surgical procedure was performed some days after the diagnosis because the
calcium serum levels had returned to normal values with significant improvement of the clinical conditions, despite persistence of high PTH values.