Diabetes due to recurrent pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism
A 21-year-old woman, presented with acute onset of abdominal pain over epigastric region radiating towards back with vomiting.\nThe patient was overweight with a body mass index (BMI) of 24.8 kg/m2. General physical examination was noncontributory apart from a nodule in the lower pole of right lobe of thyroid gland. No acanthosis nigricans and hirsutism were seen. Her menstrual history was normal. Systemic examinations revealed mild hepatomegaly. However, serum amylase and lipase were high []. Abdominal ultrasonography revealed features suggestive of acute pancreatitis along with left renal calculus. There was no evidence of gall stones. The patient was diagnosed with acute pancreatitis and managed conservatively.\nThe patient's past history shows repeated episodes of abdominal pain over last 3 years, which required hospitalization. There was recurrent history of pain in the flanks and on two occasions she had passed stones while passing urine. Straight X-ray of kidney, ureter, and bladder region showed the presence of renal stones in both the kidneys. There was no history of polyuria and polydipsia. She had a history of constipation. She however did not have any behavioral or mood disorders. The patient was then diagnosed with recurrent pancreatitis and nephrolithiasis.\nDuring the course of pancreatitis she never had any hypocalcemia. On repeated occasion her serum calcium was around 10 mg/dL. Her serum albumin was within normal range. She was detected to have diabetes mellitus with HbA1c 6.9% and was put on insulin.\nLipid profile, liver function, renal function, and thyroid function tests were normal. Prothrombin time was 11.6 s (control 11.5 s) with international normalized ratio (INR) 1.01. Routine urine analysis was also normal. CT scan did not reveal any growth. Further investigation of laboratory parameters, such as serum calcium, albumin, and PTH was abnormal [].\nThyroid ultrasonography showed small, well defined, oval shaped hypoechoic structure just inferior to the lower pole of right lobe of thyroid gland suggestive of parathyroid adenoma or small lymph node [].\nAbdominal contrast-enhanced computed tomography (CECT) showed features suggestive of mild acute pancreatitis with left renal calculus. Magnetic resonance cholangiopancreatography showed chronic pancreatitis with no evidence of biliary obstruction or choledocholithiasis [].\nPatient was diagnosed with PHPT causing hypercalcemia which resulted in nephrolithiasis and recurrent pancreatitis further leading to pancreatic diabetes.