Endocrine Abstracts

Introduction: PHPT is reported to be rare in pregnancy, with 150 cases described in the literature. Its incidence is 8/100 000 in childbearing women/year. PHPT may lead to a loss of up to 50% of pregnancies through miscarriage or stillbirth, dehydration, hyperemesis, nephrolithiasis, pre-eclampsia, fractures and pancreatitis in mothers; and death, hypocalcaemia and tetany in neonates. Intrauterine growth retardation, low birth weight and pre-term labour were described. Rate of maternal and neonatal complications reaches 80%.

Case presentation: Twenty-one-year-old female was referred to clinic, complaining of generalised myalgia/arthralgia for 1 year. Diagnoses of PHPT and osteomalacia (CCa 2.66 mmol/l, PTH 142 pmol/l, ALP1700 IU/l, vitamin D13 nmol/l, skeletal survey) was made. USS of neck and Tc99m sestamibi scan confirmed presence of single large parathyroid adenoma. Parathyroid surgery was planned.

She DNA’d to any further appointments until 14 weeks pregnant, when she was seen in joint medical antenatal clinic, and underwent minimally invasive parathyroid surgery at 18+3 weeks, and benign nature of adenoma was histologically confirmed.

Post-operatively, she developed symptomatic hypocalcaemia and required daily i.v. infusions of 100 ml 10% of calcium gluconate for 5 days and pre-operatively commenced, oral treatment. On day 6, post-operatively; breathlessness and orthopnoea developed. Clinical examination revealed bilateral lung crepitations with lower limbs and sacral pitting oedema. Chest X-ray indicated left ventricular failure and cardiomegaly. Troponin T was negative. ECG normal. CCa was 1.87 mmol/l. She started on diuretics and calcium replacement and swiftly recovered. Next day ECHO showed normal LV/RV and LVEF 70%. CCF secondary to hypocalcaemia-induced transient cardiomyopathy diagnosed.

Patient monitored in antenatal clinic until healthy baby delivered at 38 weeks.

Conclusion: We show a multidisciplinary approach to management of PHPT in pregnancy and safety of the parathyroidectomy in 2nd trimester. Post-operative cardiomyopathy and CCF, exacerbated by ‘hungry bones’ and vitamin D deficiency related hypocalcaemia, is the first report of such complication in pregnancy.