DOI: 10.36347/sasjs

Pages: 107-112

Hyperparathyroidism presenting with a Gastrointestinal bleed is a rare occurence, and is mostly associated with an parathyroid adenoma. In primary hyperparathyroidism, the incidence of gastrointestinal bleeding is greater in patients with MEN syndrome and is rarely seen in patients with only a parathyroid adenoma/hyperplasia . In case of tertiary hyperparathyroidism, it is known that CKD patients have a significantly deranged clotting mechanism due to altered nitrous oxide (NO) metabolism and uraemic toxemia. Also erosive gastritis and angiodysplasia are frequent causes of upper G.I bleeding in these patients. We here by present a case report of 63 years old male presented with complaints of passing blackish stools along with multiple episodes of nausea and vomiting since 15 days with a background of known case of hypertension , with chronic kidney disease which was recently diagnosed and being treated. Per rectal examination done was having stool mixed with black colored blood. The upper G.I endoscopy was suggestive of ulcer at the duodenum part one with no active bleed and colonoscopy was normal . Further investigations were done and it was found that patient had a raised 24hr urinary calcium levels of 294 mg\dl and a parathyroid hormone levels of 1732.1 pg\ml. Tc 99 sestamibi scan shown single left lower parathyroid nodule, hence diagnosis of primary hyperparathyroidism was made and patient underwent an open parathyroidectomy