Diagnosis and treatment of the pancreatitis as an initial manifestation of primary hyperparathyroidism：             A report of 6 cases        HE Liang*, ZHANG Hao, ZHANG Ping, et al. *Department of General Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
Corresponding author: ZHANG Hao，E-mail: haozhang@mail.cmu.edu.cn
Abstract    Objective    To evaluate the clinical characteristics, diagnosis and treatment of the pancreatitis as an initial manifestation of primary hyperparathyroidism (PHPT). Methods    The clinical data of 6 cases of the pancreatitis as an initial manifestation of PHPT admitted from February 2009 to March 2013 in Department of General Surgery, the First Hospital of China Medical University were reviewed retrospectively for the diagnosis and treatment strategies. Results   Of 6 patients with PHPT, 4 patients complicated with acute pancreatitis and 2 patients complicated with chronic pancreatitis. Four patients with acute pancreatitis presented rapid progression. The serum calcium concentration was higher than 3.5mmol/L and the typical hypercalcemia crisis appeared in 4 patients. Resection of parathyroid adenoma was performed in 3 patients. Two patients were cured and 1 died of drug-induced liver failure. The other one without operation died of hypercalcemia crisis. Two chronic pancreatitis patients with pancreatolithiasis showed mild symptoms. Although the serum calcium concentration was higher than 3.5mmol/L, no hypercalcemia crisis appeared. They were cured after the resection of parathyroid adenoma. One of them presented recurrent pancreatitis during the follow-up period and one patient had no recurrence. Conclusion    PHPT should be suspected highly when pancreatitis appeared without common causes, especially combined with normal or elevated serum calcium concentration. Surgery is considered as the most direct and effective way to treat PHPT and could alleviate the symptom of pancreatitis and improve survival rate.