• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • 2022 NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

Perforated peptic ulcer and cachexia associated with unsuspected severe hyperparathyroidism from an occult giant parathyroid adenoma.

Sarah Pearlstein, MD, Daniel Kuriloff, MD, FACS, ECNU, Rebecca Kowalski, MD, FACS. Northwell Health

Introduction: Giant parathyroid adenomas (>3.5gm) are a rare cause of primary hyperparathyroidism (PHPT). Despite having elevated calcium and PTH levels, they usually present with asymptomatic disease, especially with the widespread use of biochemical assays in screening exams. Symptomatic hyperparathyroidism classically can present as fatigue, muscle weakness, memory loss/confusion, bone pain, abdominal pain, constipation, and nephrolithiasis. We present a case of abdominal pain and cachexia from a perforated peptic ulcer (PPU) as the first presenting sign of occult primary hyperparathyroidism from a giant parathyroid adenoma.

Case Description: A 59 year-old cachectic male presented with two days of worsening abdominal pain and nausea. The patient had no history of gastroesophageal reflux or peptic ulcer disease (PUD). On admission, serum calcium was elevated to 12.3mg/dL (upper limit 10.5mg/dL).  CT scan of the abdomen/pelvis demonstrated duodenal wall thickening with perforation and pneumoperitoneum.  There were no renal calcifications.  He was taken to the OR for a laparoscopic Graham patch and abdominal washout.  On POD1 (post-operative day 1), serum calcium remained elevated at 12.5mg/dL A PTH on POD2 was 1184 pg/mL (normal:up to 65pg/mL) confirming primary hyperparathyroidism. He was treated with intravenous fluids and furosemide, but the serum calcium remained elevated.  A SPECT/CT Sestamibi scan showed a giant left extrathyroidal mass with intense uptake, consistent with giant parathyroid adenoma. Ultrasound of the neck revealed a 5.4×2.7x 2.8cm mass. DEXA scan showed osteoporosis in the lumbar spine and left femoral neck. Serum gastrin level was normal 39pg/mL (4-200pg/mL). He underwent a parathyroidectomy. Calcium and PTH returned to normal by POD1 (9.8mg/dL, 22.6pg/dL). Pathology confirmed a giant parathyroid adenoma (3.6×3.0x1.2cm and 12gm).

Discussion: PPU is associated with a mortality of up to 30%, and morbidity of 50%. The etiology of PUD includes H pylori, NSAIDs and smoking. The association of PUD and hyperparathyroidism is well known, and studies have shown that improvement in peptic ulcer symptoms can occur after parathyroidectomy. It has been suggested that increased calcium levels due to hyperparathyroidism can lead to gastric acid hypersecretion and therefore PUD.  Peptic ulcer perforation as the first manifestation of PHPT is rare and to our knowledge the first reported case caused by giant parathyroid adenoma.

Conclusion: In patients with a perforated peptic ulcer without obvious cause, we recommend obtaining a serum calcium level, and if elevated, a PTH to rule out hyperparathyroidism. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 85618

Program Number: P166

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

122

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2018 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons