Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) commonly goes unrecognized due to the physiological changes of pregnancy.PHPT is associated with significant maternal and fetal morbidity and mortality. Current evidence supports parathyroidectomy is the main treatment, performed preferably during the second trimester, when the serum calcium is above 11–mg/dl. We report the clinical course of a woman with newly diagnosed gestational PHPT who refused minimally invasive parathyroidectomy during and after pregnancy.

Case presentation: A 23-year-old primigravida woman presented during her 35th week of gestation with a 2 day history of severe nausea and vomiting. She denied any history of abdominal pain, constipation, polydipsia, polyuria, weight loss, muscle weakness. She had no history of calcium disorders, kidney stones, fractures, osteoporosis. She was not taking any drugs which could influence her calcium status. Admission laboratory tests revealed several hypercalcemia with a adjusted calcium level 18.43 mg/dl, phosphorus 2.39 mg\dl and parathyroid hormone (PTH) 775 pg/ml serum alkaline phosphatase (ALP) 157 IU/l urinary calcium level 503 mg/24-h Ultrasound examination of her neck identified one suspicious parathyroid enlargement at the inferior pole of thyroid gland measuring 17×13×11 mm. Severe hypercalcemia was treated with i.v. saline infusion, caciitonin, diuretic and corticosteroids. She denied minimally invasive parathyroidectomy during third trimester. When her serum calcium level dropped the level of 13.5 mg\dl, cesaran section was performed. The baby was healthy and normocalcemic with a calcium level of 9.8–mg/dl and a PTH level of 121 pg/ml on day 1. After pregnancy she again refused parathyroidectomy and medical treatment and the mother and baby were discharged home on the six day after delivery.

Conclusions: Timely recognition and effective management of PHP in pregnancy is important because it represents a preventable cause of fetal and maternal morbidity and mortality.Although our case lately presented, both maternal and fetal outcomes was excellent with medical intervention.