Parathyroid adenoma in a young female presenting as recurrent acute pancreatitis with a brown tumour of the mandible—A case study

• Brown tumour and acute pancreatitis are rarely associated with parathyroid adenoma.
• A young girl presented with recurrent acute pancreatitis and Brown tumour of mandible.
• Investigations revealed a functioning solitary parathyroid adenoma.
• The parathyroid adenoma was removed surgically.
• The patient recovered uneventfully after the surgery.

INTRODUCTIONPrimary hyperparathyroidism is usually seen in females above the age of 50 years, with a prevalence of 21/1000,1 whereas the incidence in patients aged 12–28 years is less than 5%.2 A solitary adenoma is responsible for 80% of cases of primary hyperparathyroidism.3 Primary hyperparathyroidism is most commonly asymptomatic.4 The incidence of acute pancreatitis associated with hyperparathyroidism is less than 10%.5 and 6 The incidence of hyperparathyroidism associated with a Brown tumour is less than 5%.7PRESENTATION OF CASEA 19 year old female patient presented with recurrent acute pancreatitis and swelling over the mandible. Complete investigative workup revealed a solitary parathyroid adenoma causing hyperparathyroidism. Surgical exploration with excision of the parathyroid adenoma was performed, following which the patient recovered uneventfully.DISCUSSIONThe patient was initially managed as a case of acute pancreatitis, and although not suspected initially, a high index of suspicion for hyperparathyroidism developed after a biopsy of the mandibular swelling showed the presence of osteoclastic giant cells indicating the possibility of a Brown tumour. Further investigations then revealed the presence of a solitary parathyroid adenoma with coexistent hyperparathyroidism which was then managed surgically.CONCLUSIONThe young age of the patient, and her presentation with acute pancreatitis and a Brown tumour of the mandible make this an extremely rare presentation of parathyroid adenoma.