{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T19:24:12Z","timestamp":1762543452988,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,17]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>Primary hyperparathyroidism is characterised by autonomous production of parathyroid hormone resulting in hypercalcaemia. It is estimated that 12% of these patients present with peptic ulcer-related symptoms. The pathophysiological mechanism is not well established, but studies reveal serum calcium activating gastrin cell calcium receptors ultimately resulting in increased gastric acid production leading to peptic ulcer disease. A patient presented acutely to our service with peptic ulcer perforation in the context of incidentally elevated serum calcium levels. Further inpatient investigations lead to the diagnosis of primary hyperparathyroidism as the first manifestation of this patient\u2019s disease.<\/jats:p>","DOI":"10.1136\/bcr-2020-240570","type":"journal-article","created":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T14:34:32Z","timestamp":1618324472000},"page":"e240570","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Perforated gastric ulcer as the initial manifestation of hyperparathyroidism"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5044-5935","authenticated-orcid":false,"given":"Cameron","family":"Castle","sequence":"first","affiliation":[{"name":"General Surgery, Hutt Valley District Health Board, Lower Hutt, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Tietjens","sequence":"additional","affiliation":[{"name":"General Surgery, Hutt Valley District Health Board, Lower Hutt, New Zealand"},{"name":"University of Otago, Wellington, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,4,13]]},"reference":[{"key":"2025082711300193000_14.4.e240570.1","first-page":"958","article-title":"Effect of parathyroidectomy in patients with hyperparathyroidism, Zollinger-Ellison syndrome, and multiple endocrine neoplasia type I: a prospective study","volume":"102","author":"Norton","year":"1987","journal-title":"Surgery"},{"key":"2025082711300193000_14.4.e240570.2","doi-asserted-by":"crossref","first-page":"58","DOI":"10.5152\/UCD.2015.3032","article-title":"Primary hyperparathyroidism","volume":"32","author":"Madkhali","year":"2016","journal-title":"Turk J Surg"},{"key":"2025082711300193000_14.4.e240570.3","first-page":"451","article-title":"Hyperparathyroidism","volume":"29","author":"Gopinath","year":"2011","journal-title":"Surgery"},{"key":"2025082711300193000_14.4.e240570.4","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/S0011-3840(80)80006-2","article-title":"Primary hyperparathyroidism","volume":"17","author":"Wells","year":"1980","journal-title":"Curr Probl Surg"},{"key":"2025082711300193000_14.4.e240570.5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1159\/000104224","article-title":"Peptic ulcer perforation as the first manifestation of previously unknown primary hyperparathyroidism","volume":"1","author":"Efremidou","year":"2007","journal-title":"Case Rep Gastroenterol"},{"key":"2025082711300193000_14.4.e240570.6","article-title":"Two rare manifestations of primary hyperparathyroidism: paralysis and peptic ulcer bleeding","volume":"2017","author":"Heidarpour","year":"2017","journal-title":"Endocrinol Diabetes Metab Case Rep"},{"key":"2025082711300193000_14.4.e240570.7","first-page":"231","article-title":"A life-threatening duodenal ulcer hemorrhage due to previously unknown primary hyperparathyroidism","volume":"6","author":"Xie","year":"2018","journal-title":"Gastroenterol Rep"},{"key":"2025082711300193000_14.4.e240570.8","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1136\/pgmj.75.880.113","article-title":"An uncommon aetiology of perforated gastric ulcer","volume":"75","author":"Ahmad","year":"1999","journal-title":"Postgrad Med J"},{"key":"2025082711300193000_14.4.e240570.9","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M107315200"},{"key":"2025082711300193000_14.4.e240570.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-008-0637-8"},{"key":"2025082711300193000_14.4.e240570.11","doi-asserted-by":"crossref","unstructured":"Moza D , Dasgupta K , Daskalopoulou S . Hypercalcemia and upper GI symptoms. 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