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 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, 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.