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Perforated gastric ulcer as the initial manifestation of hyperparathyroidism
  1. Cameron Castle1 and
  2. James Tietjens1,2
  1. 1General Surgery, Hutt Valley District Health Board, Lower Hutt, New Zealand
  2. 2University of Otago, Wellington, New Zealand
  1. Correspondence to Dr Cameron Castle; castlecg{at}


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.

  • general surgery
  • endocrinology
  • ulcer

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  • Contributors CC and JT both contributed to the planning, conduct and reporting of the work described in this article. Both clinicians were involved in the care of the patient described in the case report. JT contributed to the idea for the article. CC performed the literature search. CC and JT wrote the article, and both take responsibility as guarantor (the contributor who accepts full responsibility for the finished article, had access to any data and controlled the decision to publish).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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