SAT-812 - Refractory Severe Hypercalcemia From Primary Hyperparathyroidism Requiring Parathyroidectomy and Complicated by Necrotizing Pancreatitis

Background:
Severe hypercalcemia due to primary hyperparathyroidism is typically responsive to medical therapy; however, refractory cases with life-threatening complications are rare.

Case Presentation:
A 51-year-old female with chronic pancreatitis and hepatic steatosis presented with altered mental status and severe hypercalcemia (serum calcium ~20 mg/dL). Laboratory evaluation demonstrated elevated parathyroid hormone levels consistent with primary hyperparathyroidism. Despite aggressive treatment with intravenous fluids, calcitonin, pamidronate, zoledronic acid, and denosumab, hypercalcemia remained refractory, necessitating urgent parathyroidectomy. Pathology confirmed parathyroid adenoma. Her course was complicated by necrotizing pancreatitis with large fluid collections requiring interventional radiology drainage, endoscopic intervention, and surgical management. Postoperatively, she developed hungry bone syndrome requiring calcium and vitamin D repletion, with subsequent improvement.

Conclusion:
This case highlights severe, treatment-refractory hypercalcemia due to primary hyperparathyroidism requiring urgent surgical intervention and underscores the association between marked hypercalcemia and necrotizing pancreatitis.

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