PANCREATIC INSUFFICIENCY AND HYPERPARATHYROIDISM

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Abstract
The case is described of a 37-year-old man with osteitis flbrosa generalisata due to a parathyroid adenoma of the chief cell type. Although excision of the adenoma cured the biochemical abnormalities in Ca metabolism, the bone disease healed very slowly. The patient gave a history of a severe attack of acute pancreatitis 8 years previously, and was found to have calcification of the pancreas. Moderately increased stool N and fat indicated the presence of partial pancreatic insufficiency. The patient also had well-compensated chronic glomerulonephritis, without N or P retention, which had first been noted after the attack of pancreatitis. A further complication was the appearance during hospitalization of acute arthritis, eventually diagnosed as gout. It is suggested that the hyper-parathyroidism was related to the pancreatic insufficiency in the following way. Failure of lipid absorption led to vitamin D deficiency which eventually produced osteomalacia. This caused hyperplasia of the parathyroids which set the stage for the appearance of a parathyroid adenoma, analogous to the occasional appearance of a functionally active adenoma of the thyroid gland in a patient with nodular goiter due to I deficiency.