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.