Endocrine Abstracts

Background: Primary hyperparathyroidism during pregnancy is rare, and may present with symptoms non-specific to hypercalcaemia.

Case: A 35 years old 12/40 weeks pregnant lady presented to accident and emergency department with 6 weeks history of nausea and vomiting. On admission she felt anxious with ongoing nausea and numbness all over the body. She was a mother 2-year-old with no significant past medical history. Her medication on admission were; folic acid 5 mg once daily, metochropromide 10 mg three times daily when required, and pregnacare ones tablets once a day. Her blood test showed Na⁺137 mmol/l, K 3.4 mmol/l, urea 2.4 mmol/l, creatinine 61 μmol/l, ALP 79 μ/l, ALT 32 μ/l, albumin 36 g/l, bilirubin 10 μmol/l, corrected Ca²⁺3.50 mmol/l, phosphate 0.71 mmol/l, magnesium 0.70 mmol/l, parathyroid hormone 15.2 pmol/l, and TSH 0.50 μ/free T₄ 9.5 pmol/l. 24 urinary calcium was elevated at 17.5 mmol/24 h. Ultrasound parathyroid revealed 9 mm left lower lobe parathyroid adenoma.She was started on i.v. fluids for 72 h and her calcium remained high at 3.05 mmol/l but she generally felt well. She was discharged home and referred to surgical team for review and consideration of surgery but she was readmitted 1 week later with general malaise and ongoing nausea and vomiting. She had parathyroidectomy at 14/40 gestation weeks with normalisation of calcium.

Discussion: Primary hyperparathyroidism may be associated with adverse outcome in the fetus and neonate. Adequate hydration and correction of electrolyte abnormalities is recommended as a first line. Pharmacological agents for treatment of primary hyperparathyroidism in pregnancy has not been adequately studied.

Parathyroidectomy in the second trimester is often recommended as definitive treatment.