Endocrine Abstracts

Newly diagnosed Primary Hyperparathyroidism during pregnancy is extremely rare condition. The diagnosis is obscured by the normal (physiological) pregnancy-induced changes that lower the total serum calcium and suppress parathyroid hormone levels. Hyperparathyroidism in itself can have a negative impact on both maternal and foetal health. However, there are no evidence-based parameters that reliably predict the outcome of hyperparathyroidism in pregnancy and optimal management remains uncertain. A 24 year old lady with MEN 1 syndrome and primary hypothyroidism was seen in Joint antenatal-endocrine clinic. She has had distal pancreatectomy for neuroendocrine lesion at age 22 yrs. Due to the background of familiar MEN1-mutation, bone profile, pituitary and gastrointestinal neoplasia screening performed prior to pregnancy were negative. At 13 weeks gestation, she was noted to have raised serum calcium at 2.73 mmol/L. Subsequent investigation confirmed persistently raised serum calcium, raised parathyroid hormone at 67 ng/L. 25 hydroxy vitamin D <12 nmol/L (reference range 24–167) Therefore, diagnosis of primary hyperparathyroidism and vitamin D deficiency were made . Ultrasound scan of neck confirmed 4×6×11 mm left lower parathyroid adenoma. Benefits as well risk related to medical and surgical management of primary hyperparathyroidism were discussed with patient. She was closely monitored with fortnightly U&E and bone profile measurement. As the mother was asymptomatic throughout the pregnancy, the foetus was growing well and her serum calcium remained <2.8 mmol/L, surgery was deferred. A healthy baby boy was delivered at 38-week gestation with an unremarkable neonatal course. This case highlights importance of close monitoring for presence/emergence of other endocrine disorders related to MEN 1 syndrome and that the management of hyperparathyroidism in pregnancy should be based on the severity of the disease, even though, published literature advocate parathyroidectomy during second trimester as treatment of choice.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.