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Case Reports |

Pancreatic Insufficiency as the Presenting Feature of Hyperparathyroidism

ANDREW L. WARSHAW, M.D.; WILLIAM D. HEIZER, M.D.; and LEONARD LASTER, M.D., F.A.C.P.
Ann Intern Med. 1968;68(1):161-167. doi:10.7326/0003-4819-68-1-161
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SUMMARY:

The fifth reported case of exocrine pancreatic insufficiency in association with a parathyroid adenoma is described. The patient presented with severe malabsorption syndrome in which diarrhea, weight loss, steatorrhea, and hypoproteinemia were prominent. She had no symptoms of pancreatitis, renal disease, or bone disease. The malabsorption syndrome was effectively treated by oral administration of pancreatic enzymes. Subsequently, the presence of hypercalcemia and increased alkaline phosphatase activity in the serum led to the discovery of a parathyroid adenoma. After removal of the adenoma, the patient became euparathyroid. A secretin test of pancreatic function was still abnormal 2 months after surgery, but the degree of steatorrhea may have been somewhat less than it had been before surgery.

It is suggested that in this patient hyperparathyroidism may have led to chronic pancreatitis and consequent injury and insufficiency. Hyperparathyroidism should be considered among the causes of pancreatic insufficiency.

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