title: Peptic ulcer perforation as the first manifestation of previously unknown primary hyperparathyroidism.
abstract: A patient admitted for acute abdomen was incidentally found with elevated serum calcium level. In surgery, under conservative treatment of the hypercalcemia, a perforated duodenal ulcer was found and simple closure was performed. Postoperatively, calcium level continued to rise, parathyroid hormone was elevated and ultrasonographic examination showed a lesion in the right anterior neck, while serum gastrin level was normal, thus documenting the diagnosis of primary hyperparathyroidism. Conservative treatment had no effect on calcium level and the patient was subjected to emergency neck exploration, where a large parathyroid adenoma was removed. After surgery, calcium and PTH levels were normalized and the patient was discharged on the 5th postoperative day. Peptic ulcer and its complications are usual manifestations of primary hyperparathyroidism, with or without increased gastrin level. On the other hand, cases of a perforation of peptic ulcer as the first clinical manifestation of primary hyperparathyroidism are extremely rare.
authors.affiliation: First Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Eleni I
authors.initials: EI
authors.lastname: Efremidou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Liratzopoulos
authors.forename: Michael S
authors.initials: MS
authors.lastname: Papageorgiou
authors.forename: Michael
authors.initials: M
authors.lastname: Karanikas
authors.forename: Evdoxia
authors.initials: E
authors.lastname: Pavlidou
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Romanidis
authors.forename: Konstantinos J
authors.initials: KJ
authors.lastname: Manolas