Jennifer Brennan, DO1, Paige Robinson, DO2, Olubunmi Olarewaju, DO2; 1Aria Health Hospital System, Morrisville, PA; 2Aria Health Hospital System, Philadelphia, PA
Introduction: Acute pancreatitis is an inflammatory state within the pancreas causing abdominal pain in its most minor form, and end organ dysfunction or death in its most severe form. Pancreatitis remains the leading cause of gastrointestinal-related hospitalizations in the USA. The most common etiology is gallstone induced, though other causes include alcohol, hypertriglyceridemia, hypercalcemia, trauma and infection. Hypercalcemia-induced pancreatitis is rare, and often associated with hyperparathyroidism and malignancy.
Methods: A 75-year-old female with a history of osteopenia presented to the hospital for one day of weakness. She also reported mild abdominal discomfort and anorexia, though denied other associated symptoms. She denied any current or past alcohol use, or abdominal trauma. On physical examination, the patient was noted to be a thin, elderly female with a benign abdominal examination.
Laboratory values were significant for elevated lipase, normal liver function panel, and severely elevated calcium level. The patient underwent a CT scan of her abdomen that revealed signs of pancreatitis, with peripancreatic fluid and stranding. She underwent evaluation for common causes of pancreatitis, including abdominal ultrasound and lipid panel, that ruled out cholelithiasis and hypertriglyceridemia, respectively. Workup of her hypercalcemia showed normal levels of parathyroid and thyroid hormones, SPEP and UPEP ruled out multiple myeloma, and full body CT and bone scans ruled out solid tumor malignancy.
The patient admitted to taking increased amounts of calcium supplementation over the preceding months, and her final diagnosis was pancreatitis secondary to calcium supplementation. She was treated with intravenous fluids and calcitonin, and her calcium supplementation was discontinued. The patient was not treated with bisphosphonates given an acute kidney injury on initial labs. The patient’s chemical abnormalities, abdominal pain, and anorexia resolved within 48 hours of initiating treatment. Discussion: While uncommon, hypercalcemia is a known cause of pancreatitis. The precise pathophysiology of hypercalcemia-induced pancreatitis remains unclear, leading to a lack of targeted treatment. After extensive testing, this patient was diagnosed with severe hypercalcemia-induced pancreatitis due to calcium over-supplementation. The patient was treated with calcium reducing methods and had complete resolution of her symptoms.
Disclosures: Jennifer Brennan indicated no relevant financial relationships. Paige Robinson indicated no relevant financial relationships. Olubunmi Olarewaju indicated no relevant financial relationships.