Endocrine Abstracts

Primary hyperparathyroidism (PHP) during pregnancy is associated with high risk of maternal, foetal and neonatal mortality. Maternal and foetal complications have been reported in 67 and 80% of cases respectively. Guidelines for the management of PHP in adults exist, but there is no clear consensus regarding optimal management of PHP during pregnancy. We describe a case of PHP managed conservatively during pregnancy, resulting in the delivery of a healthy baby.

A 32-year-old lady with a known history of gallstones was admitted with cholecystitis. She was noted to have an elevated serum corrected calcium of 2.64 mmol/l (2.1–2.6 mmol/l). Further investigation revealed an elevated plasma parathyroid hormone concentration of 140 pg/ml (10–85 pg/ml), vitamin D level of 73 nmol/l (>50 nmol/l) and 24 h urinary calcium level of 4.51 mmol/l (3–9 mmol/l), consistent with a diagnosis of PHP. She had no past history of fractures, renal calculi or chronic kidney disease. DEXA scan confirmed osteopenia. TcMIBI scan localised a parathyroid adenoma and she was referred for consideration of surgery.

When she attended the surgical clinic, she was 9 weeks pregnant. After discussion with the patient, a conservative approach was favoured, delaying surgical resection until after delivery. Surgery in the second trimester was considered as a possible option should she become symptomatic.

She adhered to a eucalcaemic diet and maintained adequate hydration. She was closely monitored with monthly bone profile measurement. She remained asymptomatic throughout pregnancy, foetal growth was satisfactory and serum calcium ranged from 2.52–2.87 mmol/l. A healthy baby, weighing 3.1 kg was delivered at 38+1 weeks gestation. Maternal and neonatal calcium levels were monitored and were satisfactory following delivery. There were no signs of neonatal hypocalcaemic tetany. A left parathyroid adenoma was excised at 6 months post-partum.

This case demonstrates the importance of an individualised management plan, based on severity of disease, symptoms and gestational age. Increased awareness and careful management are key to decreasing complications associated with the condition.