Peptic Ulcer Perforation as the First Manifestation of Previously Unknown Primary Hyperparathyroidism

Efremidou, Eleni I; Liratzopoulos, Nikolaos; Papageorgiou, Michael; Karanikas, Michael; Pavlidou, Evdoxia; Romanidis, Κonstantinos; Manolas, Konstantinos J

doi:10.1159/000104224

Cited by 6 publications

(7 citation statements)

References 15 publications

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“…Previous case reports have similar findings, wherein patients presented with acute abdomen features secondary to undiagnosed hyperparathyroidism [12,16]. A 48-year-old patient presented to the hospital with sudden onset acute mid-epigastric abdominal pain accompanied by nausea and symptoms of dyspepsia and nausea for 15 days [12]. This patient had rebound tenderness, guarding, and absence of bowel sounds on the clinical examination, and a chest radiograph showed pneumoperitoneum just like our patient.…”

Section: Discussionsupporting

confidence: 82%

“…A rare but clinically important manifestation of hypercalcemia is the development of a PUD. It is reported that up to 12% of patients with primary hyperparathyroidism have peptic ulcer-related symptoms [ 12 , 16 , 17 ]. The mechanism of how hypercalcemia leads to PUD is not well established, but several studies back the notion that excess calcium activates the stomach calcium-sensing receptor located on the basolateral membrane of gastric parietal cells, which in turn increases gastric acid secretion [ 12 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hypercalcemia can also result in cardiac arrhythmias, acute kidney injury, and nephrogenic diabetes insipidus. Peptic ulcer disease (PUD) is a known complication of hyperparathyroidism, but peptic ulcer perforation (PUP) is rare and has only been reported in a few cases [10][11][12]. Perforated peptic ulcer (PPU) is a serious complication of PUD, and PUP often leads to the acute abdomen, a serious medical emergency that is associated with high morbidity and mortality [13].…”

Section: Introductionmentioning

confidence: 99%

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A Rare Manifestation of Unknown Hyperparathyroidism as a Perforated Peptic Ulcer

Mlawa¹,

Khan²,

Azhar³

et al. 2023

Cureus

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Hypercalcemia is a common electrolyte abnormality with different causes. Hypercalcemia is most often associated with malignancy and primary hyperparathyroidism and malignancy together account for most cases. Primary hyperparathyroidism manifests as hypercalcemia owing to the overproduction of parathyroid hormone. In most cases, primary hyperparathyroidism manifests due to a solitary parathyroid adenoma. Based on calcium levels, hypercalcemia can be classified as mild, moderate, and severe. Hypercalcemia typically presents with non-specific clinical features. Here, we present the case of a 38-yearold male patient who presented to the emergency department (ED) with acute abdominal pain and a tender abdomen with absent bowel sounds. He had chest radiography and blood tests initially. Chest radiography showed left-sided pneumoperitoneum, and the patient was suspected to have a perforated peptic ulcer due to hypercalcemia secondary to a parathyroid adenoma during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. The findings were confirmed by a computerized tomography scan of the abdomen, and the patient was treated with intravenous fluids for hypercalcemia and was managed conservatively for a sealed perforated peptic ulcer following discussion in the multi-disciplinary team meeting (MDT). The COVID-19 pandemic led to a long waiting list and delays in the timely management of patients requiring elective surgical intervention, such as parathyroidectomy. The patient made a complete recovery and had parathyroidectomy of the inferior right lobe two months later.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Rare Manifestation of Unknown Hyperparathyroidism as a Perforated Peptic Ulcer

Mlawa¹,

Khan²,

Azhar³

et al. 2023

Cureus

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“…The fact is that less than 15% of patients with primary hyperparathyroidism have symptoms of peptic ulcer, and these symptoms can be relieved after treatment of hyperparathyroidism. Peptic ulcer bleeding due to primary hyperparathyroidism is rare ( 9 ). Hypocalcemia is a common problem after parathyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

Two rare manifestations of primary hyperparathyroidism: paralysis and peptic ulcer bleeding

Heidarpour

Karami

Hedayat

et al. 2017

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Primary hyperparathyroidism revealed by thoracic spine brown tumor and peptic ulcer bleeding is rare. We presented a case of 33-year-old male patient who was admitted with paraplegia. Thoracic spine magnetic resonance imaging (MRI) showed extradural lesion at T4 level. He underwent surgical decompression in T4. According to histopathologic finding and elevated serum parathormone (PTH) and hypercalcemia (total serum calcium 12.1 mg/dL), the diagnosis of brown tumor was down. Ultrasonography of his neck showed a well-defined lesion of 26 × 14 × 6 mm. The day after surgery, he experienced 2 episodes of melena. Bedside upper gastrointestinal endoscopy showed gastric peptic ulcer with visible vessel. Treatment with intragastric local instillation of epinephrine and argon plasma coagulation was done to stop bleeding. After stabilization of the patient, parathyroidectomy was performed. Histologic study showed the parathyroid adenoma without any manifestation of malignancy. At discharge, serum calcium was normal (8.6 mg/dL). On 40th day of discharge, standing and walking status was normal.Learning points:Thoracic spine involvement is a very rare presentation of primary hyperparathyroidism.The issue of whether primary hyperparathyroidism increases the risk of peptic ulcer disease remains controversial. However, gastrointestinal involvement has been reported in association with classic severe primary hyperparathyroidism.The treatment of brown tumor varies from case to case.

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“…В последнее время исследований, посвященных изучению клинического течения ЯБ при ПГПТ, не так много. В литературе описывается несколько случаев манифестации ПГПТ в виде желудочно-кишечного кровотечения при перфорации язвы желудка [29,30]. В исследовании А. Jodkowska и соавт.…”

Section: язвенная болезнь желудкаunclassified

Pathology of the Gastrointestinal Tract in Patients with Primary Hyperparathyroidism

Baranova

Баранов

2023

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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Aim. To present data of Russian and foreign studies on the prevalence, pathogenesis and clinical picture of gastrointestinal tract (GIT) pathology in patients with primary hyperparathyroidism (PHPT).Key point. At the beginning of the 20th century PHPT was considered a severe endocrine disease with specific bone and kidney complications, however in 1957 W.T. St Goar proposed a mnemonic triad to recognize this pathology as “diseases of stones, bones and abdominal groans”. A high frequency of gastrointestinal complaints, peptic ulcer, pancreatitis, cholelithiasis in patients with PHPT has been reported. Hyperparathyroidism has been shown to cause smooth muscle atony with specific upper and lower GI symptoms such as nausea, heartburn and constipation. The prevalence of peptic ulcer in patients with PHPT, according to studies of the 50s–60s of the last century, ranged from 10 to 25 %. However, studies linking PHPT to peptic ulcer development were performed before the advent of proton 1). On the other hand, the development of pancreatitis in PHPT is one of the most studied pathologies. In developing countries its frequency can reach 10–20 % due to the absence of routine screening for blood calcium. Some authors report the impact of elevated parathyroid hormone levels on the formation of gallbladder stones by inhibiting of gallbladder emptying, hepatic bile secretion and mobility of the sphincter Oddi, and changing of the bile composition. A number of studies have found an increased risk of developing malignant neoplasms of the intestine, especially the colon, in patients with PHPT.Conclusion. The digestive manifestations of parathyroid dysfunction in patients can often be overlooked, and serum calcium levels should be included in the routine examination in the presence of abdominal symptoms.

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Peptic Ulcer Perforation as the First Manifestation of Previously Unknown Primary Hyperparathyroidism

Cited by 6 publications

References 15 publications

A Rare Manifestation of Unknown Hyperparathyroidism as a Perforated Peptic Ulcer

A Rare Manifestation of Unknown Hyperparathyroidism as a Perforated Peptic Ulcer

Two rare manifestations of primary hyperparathyroidism: paralysis and peptic ulcer bleeding

Pathology of the Gastrointestinal Tract in Patients with Primary Hyperparathyroidism

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