Co-presentation of obstructive jaundice and primary hyperparathyroidism leading to diagnosis of cholangiocarcinoma

Abstract

Cholangiocarcinomas account for approximately three percent of all gastrointestinal malignancies. Although these cancers are rare in the United States, their frequency is increasing globally. These cancers are highly lethal because most are locally advanced at presentation and unresectable. Various studies have shown association between choledocholithiasis and cholangiocarcinoma.1,2 Other major risk factors identified include primary sclerosing cholangitis, inflammatory bowel disease, thorotrast, fibropolycystic liver disease, choledochal cysts, Caroli’s disease. Some genetic conditions such as Lynch syndrome and biliary papillomatosis also increase the risk for cholangiocarcinoma.3,4 Our case describes interesting finding of co–presentation of primary hyperparathyroidism (PHPT) along with cholangiocarcinoma. This makes the case intriguing as patient presented with symptoms of hypercalcemia, obstructive jaundice and pancreatitis initially thought to be secondary to PHPT. Later, diagnosis of cholangiocarcinoma makes PHPT just an incidental finding rather than cause of choledocholithiasis and subsequent cholangocarcinoma. Although PHPT can rarely present as pancreatitis due to biliary tract stones,5,6 no causal association has been described between PHPT and cholangiocarcinoma.