Endocrine Abstracts

Introduction: Hyperparathyroidism during pregnancy is a serious problem. Appropriate management is a matter of debate. We would like to present cases in which, PHP was diagnosed in completely different circumstances, though end up with various pregnancy outcomes.

Case report: First patient was 29-year-old women in 21th week of her second pregnancy admitted to our ward due to suspected relapse of Graves’ disease and possible adrenal dysfunction. She presented with weakness, abdominal pains, vertigo in 7th week of pregnancy. During hospitalisation, previous suspicions were ruled out. Unexpectedly, we discovered elevated concentration of total calcium. After thorough examination, we confirmed a diagnosis of hyperparathyroidism. Owing to biochemical deterioration she was operated in 24th gestation week. The women gave birth to a healthy baby girl in 40th week of gestation. Second patient was 28-year-old women admitted to Outpatient Endocrinology Clinic due to hypercalcaemia. Medical history revealed miscarriage in 9th week. During pregnancy which she lost, calcium levels were very high. On the day of visit neck ultrasonography depicted a hypoechoic region which could be consistent with enlarged parathyroid gland. She was operated. Frozen section pathology and intraoperative PTH assay confirmed diagnosis of parathyroid adenoma and curative procedure.

Conclusion: Presented cases highlight the importance of controlling calcium-phosphate balance in pregnancy. Decisions concerning method of treatment PHP are difficult. When conservative procedures are introduced, mother and her child should remain under strict control. On the other hand operation during pregnancy is hazardous. Our experience gives a novel insight into that complicated problem. Taking into account possible adverse effect of PHP on health of both women and fetus there are growing evidence pro surgery, regardless of gestational age.