Postoperative hyperamylasemia, pancreatitis, and primary hyperparathyroidism

One hundred patients with biochemically proved primary hyperparathyroidism had serum amylase estimations before and after cervical or mediastinal exploration. After operation the patients were monitored for the development of abdominal symptoms suggestive of pancreatitis. Although hyperamylasemia occurred in four patients after operation, clinical acute pancreatitis did not arise. Amylase fractionation confirmed the presence of excessive salivary isoamylase in all four patients. Operation on patients were marginally elevated serum creatinine concentrations, those receiving furosemide and those undergoing concomitant thyroid operation appeared to increase the likelihood of salivary-based hyperamylasemia; this finding suggested an altered renal handling of amylase in the immediate postoperative period. The results of this prospective study and reviewed reports of additional patients undergoing parathyroidectomy indicate that this opertion is unlikely to be complicated by postoperative pancreatitis. The probable risk of both pancreatitis and hyperamylasemia would appear to be no more than that with other nonabdominal surgical procedures.