PDF(Pubmed)
Abstract：
BACKGROUND: Hypercalcemia can be a rare contributor to acute pancreatitis (AP) in pregnancy. This is primarily due to primary hyperparathyroidism (PHPT), resulting from parathyroid carcinoma. We exhibited a case report to analyze the diagnosis and treatment during the onset of hypercalcemia-induced AP.
METHODS: A 32-year-old primigravida presented with acute pancreatitis near full-term gestation. Following a cesarean delivery, there was a reduction in serum amylase and peripancreatic exudate, but her serum calcium concentrations persistently elevated over 4.0 mmol/L. Interventions to lower the hypercalcemia were only temporarily effective, until a high serum parathyroid hormone (PTH) concentration of 1404 pg/mL was detected. Ultrasound revealed a 31 mm × 24 mm hypoechoic oval nodule in the left lower lobe of the thyroid gland. She underwent a parathyroidectomy, resulting in a dramatic decrease in serum PTH level, from preoperative levels of 2051 pg/mL to 299 pg/mL just 20 minutes after removal. Similarly, her serum calcium declined from 3.82 mmol/L to 1.73 mmol/L within 24 hours postoperatively. The final histopathology suggested parathyroid carcinoma.
CONCLUSIONS: When refractory hypercalcemia is present, serum PTH levels should be measured to determine PHPT. Parathyroidectomy is the optimal strategy for alleviating hypercalcemia and clarifying the underlying pathology.
METHODS: A 32-year-old primigravida presented with acute pancreatitis near full-term gestation. Following a cesarean delivery, there was a reduction in serum amylase and peripancreatic exudate, but her serum calcium concentrations persistently elevated over 4.0 mmol/L. Interventions to lower the hypercalcemia were only temporarily effective, until a high serum parathyroid hormone (PTH) concentration of 1404 pg/mL was detected. Ultrasound revealed a 31 mm × 24 mm hypoechoic oval nodule in the left lower lobe of the thyroid gland. She underwent a parathyroidectomy, resulting in a dramatic decrease in serum PTH level, from preoperative levels of 2051 pg/mL to 299 pg/mL just 20 minutes after removal. Similarly, her serum calcium declined from 3.82 mmol/L to 1.73 mmol/L within 24 hours postoperatively. The final histopathology suggested parathyroid carcinoma.
CONCLUSIONS: When refractory hypercalcemia is present, serum PTH levels should be measured to determine PHPT. Parathyroidectomy is the optimal strategy for alleviating hypercalcemia and clarifying the underlying pathology.
摘要：
背景：高钙血症可能是妊娠期急性胰腺炎（AP）的一种罕见因素。这主要是由于原发性甲状旁腺功能亢进（PHPT），甲状旁腺癌引起的.我们展示了一例病例报告，以分析高钙血症引起的AP发作期间的诊断和治疗。
方法：一名32岁的primigravida在足月妊娠期间出现急性胰腺炎。剖腹产后,血清淀粉酶和胰周渗出物减少,但是她的血清钙浓度持续升高超过4.0mmol/L。降低高钙血症的干预措施只是暂时有效，直到检测到1404pg/mL的高血清甲状旁腺激素（PTH）浓度。超声显示甲状腺左下叶有一个31mm×24mm的低回声椭圆形结节。她做了甲状旁腺切除术,导致血清PTH水平急剧下降，从2051pg/mL到299pg/mL的术前水平仅在切除后20分钟。同样，术后24小时血清钙从3.82mmol/L降至1.73mmol/L。最终的组织病理学提示甲状旁腺癌。
结论：当出现难治性高钙血症时，应测量血清PTH水平以确定PHPT。甲状旁腺切除术是缓解高钙血症和明确潜在病理的最佳策略。
方法：一名32岁的primigravida在足月妊娠期间出现急性胰腺炎。剖腹产后,血清淀粉酶和胰周渗出物减少,但是她的血清钙浓度持续升高超过4.0mmol/L。降低高钙血症的干预措施只是暂时有效，直到检测到1404pg/mL的高血清甲状旁腺激素（PTH）浓度。超声显示甲状腺左下叶有一个31mm×24mm的低回声椭圆形结节。她做了甲状旁腺切除术,导致血清PTH水平急剧下降，从2051pg/mL到299pg/mL的术前水平仅在切除后20分钟。同样，术后24小时血清钙从3.82mmol/L降至1.73mmol/L。最终的组织病理学提示甲状旁腺癌。
结论：当出现难治性高钙血症时，应测量血清PTH水平以确定PHPT。甲状旁腺切除术是缓解高钙血症和明确潜在病理的最佳策略。
