SAT-776 Endocrine Cause of Recurrent Pancreatitis: From Diagnosis to Treatment

Abstract Disclosure: A. Lazarev: None. R. Aguilar Guerrero: None. V. Florova: None. A 52-year-old woman with a previous history of unknown thyroid cancer and subtotal thyroidectomy, postsurgical hypothyroidism and diabetes mellitus, presented to the primary care clinic after a recent hospitalization for her third episode of pancreatitis. Extensive diagnostic search led to chronic hypercalcemia being the cause of her recurrent pancreatitis, and efforts were made to identify the etiology of her hypercalcemia. During these three episodes, her calcium (Ca) levels were consistently elevated, ranging 10.5-12.1 mg/dL with ionized Ca levels elevated (1.34-1.4 mmol/L). Fractional excretion of Ca was 0.027, with total Ca excretion of 463.2 mg in 24 hours. Intact PTH levels ranged 62.7-77 pg/mL, which was high normal. Vitamin D 25-OH levels were 23 -39 ng/mL, and phosphorus levels ranged from 2.4-2.8 mg/dL. The patient also underwent a 99mTc-Sestamibi scintigraphy parathyroid scan, which showed mild activity in the left thyroid gland on both early and delayed images, but no persistent focus of increased activity. A parathyroid ultrasound showed no mass in the thyroid bed. The etiology of hypercalcemia was unclear to the treating staff at this point. When the patient was evaluated in the clinic, review of her medical and surgical history revealed that she was diagnosed with multinodular goiter and had undergone a subtotal thyroidectomy with small remnants of thyroid tissue near bilateral recurrent laryngeal nerves. The pathology report indicated an incidental papillary microcarcinoma, 0.2 cm in greatest extent, which was completely excised, arising in a background of extensive lymphocytic thyroiditis. Although not specified in the report, the patient was informed by her surgeon that three out of four of her parathyroid glands had been removed. Given confirmed persistent hypercalcemia and unsuppressed PTH levels, the patient was preliminarily diagnosed with hyperparathyroidism. To prevent further episodes of hypercalcemia-related pancreatitis, she was started on cinacalcet 30 mg twice daily, which resulted in a reduction of her Ca levels to 9.2 mg/dL. Additionally, it was also considered that patient was recently diagnosed with kidney stones and a mild compression fracture of the L5 vertebra which seemed as additional indications for definitive treatment, and she was referred to a high-volume endocrine surgeon for consideration of parathyroidectomy. In conclusion, hypercalcemia is a common cause of pancreatitis. In hypercalcemic patients, PTH should be suppressed; inappropriately normal PTH levels indicate PTH overproduction. A normal Sestamibi scan does not rule out parathyroid disease. Cinacalcet might be used short-term to lower Ca levels in patients suffering from recurrent pancreatitis in the setting of PTH-dependent hypercalcemia. Presentation: Saturday, July 12, 2025