Gastrointestinal Manifestations of Primary Hyperaparathyroidims (PHPT)

  • PHPT has been associated with peptic ulcer disease:
    • In experimental animals:
      • Hypergastrinemia has been shown to result from PTH infusion into blood vessels supplying the stomach, independent of its effects on serum calcium:
        • The fact is that 12% of patients with primary hyperparathyroidism have peptic ulcer-related symptoms
  • An increased incidence of pancreatitis also has been reported in patients with PHPT:
    • Although this appears to occur only in patients with profound hypercalcemia:
      • Ca2+ ⩾12.5 mg/dL
    • Prevalence:
      • 3.6% (range: 1.5% to 15.3%) 
    • Mechanism:
      • Calcium deposition in the pancreatic ducts
      • Calcium activation of trypsinogen
  • Patients with PHPT also have an increased incidence of cholelithiasis:
    • Presumably due to:
      • PTH inhibition of:
        • Gallbladder emptying
        • Hepatic bile secretion
        • Sphincter Oddi motility
        • As well as modification of bile composition:
          • An increase in biliary calcium:
            • Which leads to the formation of calcium bilirubinate stones
    • The incidence has been reported as high as 25%

#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #HeadandNeckSurgeon #EndocrineSurgery #Hyperparathyroidism #Hypercalcemia #CASO #CenterforAdvancedSurgicalOncology

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