Endocrine Abstracts

Introduction: It is supposed that primary hyperparathyroidism (pHPT) during pregnancy is associated with significant maternal and fetal risks as high as 67 and 80%, respectively. The very few case reports published referred mainly to unrecognized pHPT or diagnosed during pregnancy. We report the case of a woman with known asymptomatic pHPT who became pregnant.

Case-report: A woman, 29 years, was diagnosed with pHPT a year before becoming pregnant; her biochemistries were: serum total Ca=11.1 mg/dl (8.6–10.3); P=2.52 mg/dl; PTH=120.8 pg/ml (15–65); 25OHD=4 ng/dl (end of spring) and Ca=11.5 mg/dl; PTH=126.3 pg/ml; 25OHD=24.9 ng /dl (end of summer). She had normal lumbar spine (LS) BMD despite a very high remodeling rate, with serum crosslaps=1.273 ng/ml and osteocalcin =33.42 ng/ml; localization studies were negative and surgery was postponed. She became pregnant and her biochemistries were: Ca=11.1 mg/dl; PTH=144.8 pg/ml; 25OHD=28.6 ng/ml (summer). During the last trimester of pregnancy, she was supplemented with oral vitamin D 1000 IU/day; corrected total Ca was 11 mg/dl, PTH 143 pg/ml. The pregnancy was uneventful until the 36th week of gestation, when premature rupture of the membranes occurred and a caesarian section was performed. The male newborn weighed 3200 g and no abnormalities were noted on physical examination. I.v. calcium and oral vitamin D (500 U/day) were started immediately; ionized calcium had a nadir at 1.28 mmol/l (total calcium 8.12 mg/dl) in the 5th day, when oral calcium was started. After 1 month his biochemistries were: total Ca=10.59 mg/dl (9–11); P=6.68 mg/dl (3.1–6); PTH=12.1 pg/ml (15–68); 25OHD=19.5 ng/ml. One month after delivery, the mother had a total Ca=10.9 mg/dl; P=2.7 mg/dl; PTH=213 pg/ml; 25OHD=34.5 ng/ml and lost 11.6% of LS BMD.

Conclusion: Vitamin D repletion of the mother with mild pHPT is safe and could prevent neonatal hypocalcemia.