Perforated gastric ulcer as the initial manifestation of hyperparathyroidism.

Cameron Castle, James Tietjens

BMJ case reports 2021 Apr 13

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Primary hyperparathyroidism is characterised by autonomous production of parathyroid hormone resulting in hypercalcaemia. It is estimated that 12% of these patients present with peptic ulcer-related symptoms. The pathophysiological mechanism is not well established, but studies reveal serum calcium activating gastrin cell calcium receptors ultimately resulting in increased gastric acid production leading to peptic ulcer disease. A patient presented acutely to our service with peptic ulcer perforation in the context of incidentally elevated serum calcium levels. Further inpatient investigations lead to the diagnosis of primary hyperparathyroidism as the first manifestation of this patient's disease. © BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.