From the FDA Drug Label
WARNINGS AND PRECAUTIONS • Upper Gastrointestinal (GI) Bleeding: Patients with risk factors for upper GI bleeding may be at increased risk. Monitor patients and promptly evaluate and treat any suspected GI bleeding. (5. 2)
The FDA drug label does not directly answer if hyperparathyroidism can cause gastrointestinal (GI) bleeding. The label mentions upper GI bleeding as a potential risk for patients taking cinacalcet, but it does not specify hyperparathyroidism as a cause of GI bleeding 1.
From the Research
Hyperparathyroidism can indirectly contribute to gastrointestinal (GI) bleeding through several mechanisms, including peptic ulcer disease, pancreatitis, and angiodysplasia, as evidenced by a case report of a life-threatening duodenal ulcer hemorrhage due to primary hyperparathyroidism 2.
Mechanisms of GI Bleeding in Hyperparathyroidism
- Elevated calcium levels can increase gastric acid secretion, potentially contributing to peptic ulcer disease
- Patients with hyperparathyroidism have a higher risk of developing pancreatitis, which can be associated with gastric erosions and bleeding
- Association between hyperparathyroidism and increased risk of angiodysplasia in the GI tract, which can lead to bleeding
- Constipation caused by hyperparathyroidism can lead to straining and development of conditions like hemorrhoids or anal fissures that can bleed
Importance of Addressing Underlying Hyperparathyroidism
- If a patient with hyperparathyroidism experiences GI bleeding, it's essential to investigate other common causes of GI bleeding while addressing the underlying hyperparathyroidism
- Treatment of hyperparathyroidism, typically through surgical removal of the affected parathyroid gland(s) or medical management with calcimimetics like cinacalcet, can help alleviate GI bleeding symptoms
Recent Evidence
- A 2017 case report highlighted the rare manifestation of primary hyperparathyroidism as peptic ulcer bleeding, emphasizing the need for prompt diagnosis and treatment 3
- A 2018 study reported a case of life-threatening duodenal ulcer hemorrhage due to primary hyperparathyroidism, underscoring the importance of considering hyperparathyroidism in the differential diagnosis of GI bleeding 2