Endocrine Abstracts

Primary hyperparathyroidism (HPT) in pregnancy is an uncommon phenomenon, mostly occurring in the 2nd or 3rd trimester. HPT in pregnancy may cause complications affecting both the mother (renal stones, pancreatitis) and fetus (neonatal tetany, seizures, intra-uterine growth retardation and preterm labour). We report two recent cases that highlight the potential risks.

Results: The patients, 37 and 35 years old at presentation respectively, both presented with symptomatic hypercalcaemia. Diagnosis was proven biochemically. One had undergone localisation studies at another centre pre-pregnancy and fallen pregnant during work-up.

Patient 1 only had pre-op ultrasound localisation showing an enlarged right inferior gland. Patient 2 who presented pre-pregnancy had had a negative sestaMIBI performed at another centre and an ultrasound showing two likely adenomas. At surgery 5 gland hyperplasia was found. Patient 1 underwent minimally invasive parathyroidectomy and a 4.8 g adenoma was removed. She has persistent hyperparathyroidism and re-localisation post partum localises a left inferior gland. She is awaiting a bilateral re-exploration. Both patients are undergoing genetic screening. Both went on to have uncomplicated deliveries and healthy babies.

Conclusions: HPT in pregnancy typically affects a young age group where multiple gland disease and inherited syndromes are more common. Localisation studies with USS without sestaMIBI may be misleading. Given the limitations of localisation, a bilateral exploration in the second trimester +/− use of intra-operative PTH assay is advisable. Young women being investigated for hypercalcaemia should be advised to avoid pregnancy until fully investigated and treated. An MDT with endocrinologists, endocrine surgeons, obstetric physicians, radiologists and geneticists is required for optimal management.