review of literature on clinical pancreatology - The Pancreapedia

indications [204].Hypercalcemia-induced pancreatitisHypercalcemia due to hyperparathyroidism is a rare etiology for acute pancreatitis, oscillatingbetween 1.5 and 7 percent in the different series. Although the cause-effect relationship andthe pathophysiology <strong>of</strong> the condition are not clear, it seems that the association among themis not incidental, and serum calcium could be a major risk factor, so that pancreatitis wouldcome to occur during severe hypercalcemia attacks. Mutations in different genes have beenproposed as well to justify why only some patients with primary hyperparathyroidism andhypercalcemia develop acute pancreatitis. References to cases like these ones are rare inthe <strong>literature</strong>. It was reported two patients with acute pancreatitis associated withhyperparathyroidism and hypercalcemia, one <strong>of</strong> them with a fatal outcome [205].Hypercalcemia is an important etiology to consider in the evaluation <strong>of</strong> acute pancreatitis.Not only is it a treatable cause, but understanding the basis for this etiology may provide newinsight into the common biochemical mechanisms involved in the pathogenesis <strong>of</strong>pancreatitis. It was reported a case <strong>of</strong> an 11-year-old girl with hypercalcemia due to primaryhyperparathyroidism who developed recurrent pancreatitis [206].Alcohol-induced pancreatitisThe aim <strong>of</strong> one study was to investigate the association between lifetime consumption <strong>of</strong>alcoholic beverages and cancer risk. Data were collected in a population-based case-controlstudy, conducted in Montreal in the mid-1980s, designed to assess the associations betweenhundreds <strong>of</strong> non-occupational and occupational exposures and multiple cancer sites in men.It was presented results for 13 cancer sites 83 patients with pancreas cancer in comparisonto population controls (n=507). Odds ratios (OR) were estimated for the associationsbetween lifetime consumption <strong>of</strong> total alcoholic beverages, beer, wine, and/or spirits,altogether and separately, and each cancer site, while carefully adjusting for smoking andother covariates using polytomous logistic regression. For several cancers (oesophagus,stomach, colon, liver, pancreas, lung, prostate) there was evidence <strong>of</strong> increased risk amongalcohol consumers compared with abstainers and occasional drinkers. For most sites, it wasbeer and to a lesser extent spirits consumption that drove the excess risks. The resultssupport the hypothesis that moderate and high alcohol intake levels over the lifetime mightincrease cancer risk at several sites [207].During 2006 to 2007, 78 patients with acute pancreatitis were prospectively searched for theetiology by:- Performing liver chemistry tests and transabdominal ultrasonography (US) forgallstone in every case- Measuring serum triglyceride and calcium in every case- Investigating definite drugs use or other identified etiology- Asking about the amount <strong>of</strong> alcohol ingestion (amount > 80 g/day for > 5 years wasrequired for alcoholic AP- Performing CT scan (if age > 40 years) and EUS if no etiology was identified.Of the 78 patients, the etiologies were alcohol in 32 (41 %), gallstones in 29 (37 %),miscellaneous in 13 (1 7%) and idiopathic acute pancreatitis in 4 patients (5 %). Among the45 patients <strong>of</strong> the study period (58 %) who consumed alcohol more than the definedthreshold for alcoholic acute pancreatitis, 13 (29 %) were found to have other explainablecauses <strong>of</strong> pancreatitis, i.e gallstones in 10, hypertriglyceridemia in 2 and AIDScholangiopathy in 1 patient. The authors concluded that alcohol was probably over-