Abstract
Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder after diabetes and thyroid disease. Most cases of hyperparathyroidism remain clinically silent. The clinical manifestations of hypercalcemia captured in the classic medical student mnemonic of “stones, bones, groans, and psychic moans” are often not found. Sometimes patients can present with unique complications. This case describes perforated peptic ulcer as the first presentation of primary hyperparathyroidism.
Highlights
We present a patient who was admitted for perforated peptic ulcer and found postoperatively to have symptomatic hypercalcemia with multiple organ involvement from recurrent hyperparathyroidism
Our patient illustrates that it is important to look beyond the initial presentation of any surgical emergency to identify the underlying cause of disease for definitive treatment
Peptic ulcer disease is a well-known complication of untreated PHPT; cases of a perforation of peptic ulcer as the first clinical manifestation of primary hyperparathyroidism are extremely rare
Summary
Primary hyperparathyroidism (PHPT) occurs in about 1% of the adult US population [1]. A 46-year-old male with a past medical history of right thyroidectomy, chronic kidney disease stage II, nephrolithiasis, gout, and venous thromboembolism presented with abdominal pain secondary to a perforated peptic ulcer. He underwent surgical repair and postoperatively developed acute kidney injury, acute gout, and recurrent kidney stones prompting medical consultation. His workup showed an elevated serum calcium level of 13 mg/dL(normal: 8.5-10.2 mg/dL). Pathology of the gastric specimen after surgery was negative for Helicobacter pylori
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