Peptic ulcer in primary hyperparathyroidism

Abstract

1. 1. Peptic ulcer proved by roentgenograms, surgery or autopsy was demonstrated in 9.1 per cent of a composite series of 429 unselected patients with primary hyperparathyroidism. A similar incidence of 7.7 per cent was noted in a smaller series of thirty-nine patients studied at the Peter Bent Brigham Hospital. Proved peptic ulcer in hyperparathyroidism appears to be only slightly more prevalent than that found among the general population. 2. 2. Although primary hyperparathyroidism was twice as common among females, peptic ulcer in hyperparathyroidism was observed more frequently in men (14.9 per cent) than in women (6.2 per cent). Duodenal ulcer predominated among the men and was present in all but one of the eighteen women with peptic ulcer disease. The ratio of duodenal to gastric ulcer for both sexes was 3.7:1. 3. 3. There were no unusual characteristics of peptic ulcer disease in hyperparathyroidism except for the high incidence of duodenal ulcer among women. 4. 4. Symptoms of peptic ulcer were often observed in patients with hyperparathyroidism in the absence of a demonstrable peptic ulcer. 5. 5. A review of the experimental data revealed that gastric secretion apparently is not increased in either man or animals with hyperparathyroidism. 6. 6. Peptic ulcer may not be directly related to hyperparathyroidism since (1) the symptoms of ulcer and hyperparathyroidism did not seem to parallel each other in severity, (2) the peptic ulcer generally preceded the onset of clinical hyperparathyroidism, and (3) the ulcers often persisted or became worse after removal of the parathyroid adenoma. 7. 7. Multiple parathyroid adenomas and polyendocrine adenomas were more common in the patients with hyperparathyroidism in whom peptic ulcer developed than in the group as a whole.