Endocrine Abstracts

Primary hyperparathyroidism (PHPT) is a common condition, affecting approximately 1% of the general population. In women of childbearing age, the correct diagnosis and management is particularly important since PHPT is associated with miscarriage, pre-eclampsia, intrauterine growth restriction, preterm delivery and postpartum neonatal hypocalcaemia. We describe a case series of six women diagnosed with PHPT and their management during pregnancy. In four cases, the PHPT was secondary to a parathyroid adenoma whilst in two patients, parathyroid hyperplasia was diagnosed. Four patients underwent parathyroidectomy during the second trimester of pregnancy. One patient was diagnosed during her third trimester and was managed conservatively until delivery. On further follow up, she declined surgery, her calcium levels returned to normal despite raised PTH and she remained asymptomatic. Another patient unfortunately miscarried during her first trimester and underwent a parathyroidectomy thereafter. We discuss the various diagnostic challenges including interpretation of urine calcium to creatinine clearance ratio during pregnancy, the importance of vitamin D replacement during diagnostic work up and the pros and cons of performing surgery during the 2nd trimester of pregnancy. Importantly, in three of these women, hypercalcaemia had been detected prior to conception. This highlights the importance of prompt diagnosis and if PHPT confirmed, appropriate counselling about maternal and fetal risks and the need to expedite surgery. These cases illustrate the difficulties faced in diagnosing and managing women with PHPT during pregnancy, who require close monitoring and definitive management of PHPT. In addition, fetal calcium monitoring immediately postpartum is advocated. In some cases it may also be appropriate to undertake genetic testing for multiple endocrine neoplasia, given the age of onset and presentation.