title: Parathyroid scintigraphy, histopathology correlation in patients with tropical pancreatitis and coexisting primary hyperparathyroidism.
abstract: OBJECTIVE
  Tropical pancreatitis (TP) is a juvenile, non-alcoholic type of chronic pancreatitis and is highly prevalent in Kerala, India. Increasing prevalence of TP and its varied manifestations prompted us to undertake this retrospective analysis. We attempted to study the incidence of TP in patients with primary hyperparathyroidism (PHPT) and correlate with calcium levels, scintigraphy and histopathology findings.
  
  
  METHODS
  Records of 44 hypercalcemic patients with raised parathormone (PTH) were analyzed. Clinical, biochemical and imaging findings were noted to look for diabetes mellitus and pancreatitis. All patients underwent dual phase (99m) Technetium methoxy isobutyl isonitrile parathyroid scintigraphy in our department between January 2007 and 2010. Gamma probe assisted minimally invasive parathyroidectomy was performed. Histopathological correlation was obtained in all patients.
  
  
  RESULTS
  Our study shows 18% (8/44 patients) incidence of TP in patients with PHPT (compared to 7% reported in 1970's) in Kerala. Results show involvement of middle aged, non-alcoholic males. No direct association between severity of diabetes, pancreatitis and PHPT was noted in our series. Parathyroid adenoma was the most common underlying pathology. All TP patients' clinical outcome improved post parathyroidectomy. TP patients with PHPT demonstrated adenomas, mainly composed of oxyphilic cells. Non pancreatitis group interestingly showed a varied picture of adenoma, hyperplasia with predominance of chief cells histologically.
  
  
  CONCLUSIONS
  There is a 2.6 fold increase in the incidence of TP (18%) in patients with PHPT. Hypercalcemia may be the causative factor leading to TP in PHPT patients in our limited series. The data suggests a causal association between pancreatitis and PHPT. Patients presenting with either one or a combination of hypercalcemia, pancreatic dysfunction or raised PTH need to be thoroughly evaluated as their management is interlinked.
authors.affiliation: Department of Nuclear Medicine and PET CT, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India.
authors.forename: Subramanyam
authors.initials: S
authors.lastname: Padma
authors.forename: Palaniswamy Shanmuga
authors.initials: PS
authors.lastname: Sundaram
keywords: Diabetes mellitus; parathyroid scintigraphy; single photon emission computed tomography; tropical pancreatitis
references.citation: JAMA. 1980 Jan 18;243(3):246-7
references.pmid: 7350371
references.citation: Diabetes Metab Rev. 1998 Jun;14(2):153-70
references.pmid: 9679668
references.citation: Aust N Z J Med. 1976 Aug;6(4):316-20
references.pmid: 1070989
references.citation: Indian J Gastroenterol. 2006 Mar-Apr;25(2):74-81
references.pmid: 16763335
references.citation: Med Hypotheses. 2003 Nov-Dec;61(5-6):535-42
references.pmid: 14592784
references.citation: Am Surg. 1985 Jun;51(6):325-9
references.pmid: 3994175
references.citation: Endocrinology. 1991 Dec;129(6):3269-73
references.pmid: 1659526
references.citation: Postgrad Med J. 2003 Nov;79(937):606-15
references.pmid: 14654569
references.citation: Diabetes Res Clin Pract. 2001 Jan;51(1):29-38
references.pmid: 11137179
references.citation: Acta Hepatogastroenterol (Stuttg). 1976 Apr;23(2):151-61
references.pmid: 775877
references.citation: Am J Gastroenterol. 2008 Feb;103(2):368-74
references.pmid: 18076731
references.citation: Ann Surg. 2010 Jun;251(6):1127-30
references.pmid: 20485151
references.citation: Metabolism. 2000 Nov;49(11):1501-5
references.pmid: 11092519
references.citation: Am J Kidney Dis. 1993 Jun;21(6 Suppl 3):32-8
references.pmid: 8503433
references.citation: Ann Surg. 1957 Jun;145(6):857-63
references.pmid: 13425295
references.citation: Trop Geogr Med. 1959 Mar;11(1):70-4
references.pmid: 13659585
references.citation: Mol Cell Biochem. 1998 Nov;188(1-2):129-36
references.pmid: 9823018
references.citation: Biochemistry. 1996 Dec 10;35(49):15883-9
references.pmid: 8961953
references.citation: Aust N Z J Surg. 1998 Feb;68(2):117-9
references.pmid: 9494002
references.citation: Am J Gastroenterol. 2000 Dec;95(12):3658-9
references.pmid: 11151920