Primary hyperparathyroidism (PHPT) is a common cause of hypercalcemia, most often due to a solitary parathyroid adenoma. While skeletal and renal complications are typical, pancreatitis is a rare manifestation, occurring in only 1.5–15% of cases. Hypercalcemia may trigger premature activation of pancreatic enzymes, causing inflammation, fibrosis, and calcification. Because the presentation can mimic other etiologies such as alcohol abuse or gallstone disease, PHPT may remain undiagnosed until end-organ damage occurs. This report highlights an uncommon case of chronic pancreatitis secondary to PHPT in a young Filipino male.

A 28-year-old male with no history of gallstones or obesity presented with recurrent right upper quadrant pain over four years. Initial evaluation showed elevated pancreatic enzymes and calcifications, leading to a diagnosis of pancreatitis. Despite conservative management, he experienced persistent abdominal pain. Repeat imaging revealed pancreatic duct ectasia, pseudocysts, and bilateral nephrolithiasis. Laboratory workup demonstrated hypercalcemia (ionized calcium 2.4 mmol/L) warranting zoledronic acid therapy and markedly elevated parathyroid hormone (940 pg/mL). Neck ultrasound and sestamibi scan identified a hyperfunctioning right inferior parathyroid adenoma. Bone densitometry confirmed osteoporosis.

The patient underwent right inferior parathyroidectomy with intraoperative confirmation of parathyroid adenoma. Postoperatively, he developed hypocalcemia, hypophosphatemia and hypomagnesemia consistent with hungry bone syndrome, managed with intravenous calcium and oral calcitriol. An endoscopic ultrasound guided aspiration of the pancreatic pseudocyst was also done. He was discharged asymptomatic, with normalization of calcium levels and complete resolution of abdominal pain. Follow-up imaging showed stable pancreatic changes without recurrence.

This case underscores the importance of considering PHPT in patients with recurrent or idiopathic pancreatitis, particularly when nephrolithiasis or hypercalcemia is present. Surgical removal of the offending parathyroid adenoma resulted in biochemical normalization and symptom resolution. Early recognition of PHPT can prevent irreversible pancreatic and skeletal complications, emphasizing the value of calcium and PTH screening in atypical or unexplained cases of chronic pancreatitis.