Primary hyperparathyroidism–associated pancreatitis: poor prognosis, distinct serum calcium trajectories, and proactive therapeutic implications

Background Primary hyperparathyroidism (PHPT) is an uncommon but clinically significant cause of acute pancreatitis (AP). Its clinical course and prognosis remain inadequately characterized compared to common AP etiologies. Methods A bibliometric analysis was performed to evaluate global research trends on PHPT-associated acute pancreatitis (PHPT-AP). We conducted a retrospective cohort study at Peking Union Medical College Hospital between 2000–2025. Clinical data were compared with patients with biliary and hypertriglyceridemia-induced AP. Subgroup analyses evaluated differences between PHPT with mild/moderately severe AP and severe AP (SAP), and between AP and chronic pancreatitis (CP). Statistical analyses included logistic regression and Mann–Whitney U tests. Results The bibliometric results revealed limited literatures but increasing attention to PHPT-pancreatitis. Our cohort showed PHPT-AP patients exhibited worse outcomes compared to non-PHPT-AP, with higher risks of SAP (OR 3.73, 95% CI 1.28–10.86, P = 0.016), intensive care unit admission (OR 3.79, 95% CI 1.17–12.32, P = 0.027), and in-hospital mortality (OR 12.76, 95% CI 1.52–107.3, P = 0.019). Serum calcium (median 4.2 mmol/L vs. 3.5 mmol/L, P = 0.015) and parathyroid hormone (median 1514.0 pg/mL vs. 312.0 pg/mL, P = 0.007) were significantly higher in PHPT-SAP. A three-phase calcium trajectory was observed in SAP: an initial hypercalcemic phase, a plateau under therapy, and eventual normalization after surgical or extracorporeal interventions. PHPT-CP was associated with longer PHPT duration, recurrent AP, and higher diabetes prevalence. Conclusion PHPT-AP is associated with a worse prognosis and requires proactive management. Serum calcium correlates with severity and should be monitored dynamically. Early surgery or continuous veno-venous hemofiltration may be warranted in severe cases. Prolonged PHPT with recurrent AP and lifestyle risk factors may contribute to CP.