Endocrine Abstracts

Background: Peptic ulcer bleeding due to primary hyperparathyroidism is extremely rare and only a few cases have been reported in the literature.

Material and methods: Man with repeated upper gastrointestinal bleeding, with a history of kidney stones and previously unknown primary hyperparathyroidism.

Case: Man M., 46 y.o., with a history of 4 episodes of gastrointestinal bleeding and a ten-year history of multiple kidney stones. In 2014 resection of the stomach with Roux anastomosis was conducted to arrest the hemorrhages. High level of calcium was first diagnosed. However, he had been consistently treated for ulcer and kidney stones without any further work-up. In 2018 in the therapeutic department with ulcer rebleeding: PTH – 48.7 pmol/l (1.7–6.4), calcium – 3.06 mmol/l (2.2–2.65), phosphorus – 0.8 mmol/l (0.81–1.45). Primary hyperparathyroidism was confirmed. On a neck and abdomen CT scan with contrast: two parathyroid adenomas (larger mass size 7×12×15 mm), adenoma of the right adrenal gland (18×15×21 mm) and polycystic kidney disease. Urine metanephrine – 709 μg/24 hours (20–345) and normetanephrine – 507.3 μg/24 hours (30–440), GFR level –46 ml/min/1.73 m². MRI performed and pituitary adenoma (10×8×9 mm) was found. After laboratory evaluation prolactinoma was diagnosed (PRL – 5925 mE/l (72–229). Gastrinoma was also supposed because of repeated GI-bleeding. An immunohistochemistry analysis of stomach sample from 2014 revealed neuroendocrine pancreatic tumor Ki67-25% (PPoma). Genetic examination was performed: result in processing. Parathyroidectomy and adrenalectomy were performed. Postoperatively, calcium and PTH levels were normalized. The ulcer healed – 3 months after parathyroidectomy.

Conclusion: The serum calcium level and PTH level must be considered routine tests in patients with a peptic ulcer bleeding, especially when it is accompanied by a history of kidney stones and repeated gastrointestinal bleeding.

Keywords: primary hyperparathyroidism, neuroendocrine, multiple endocrine neoplasia.