Endocrine Abstracts

Introduction: Primary hyperparathyroidism (pHPT) during pregnancy is rare and associated with increased morbidity for both mother and fetus. Maternal complications of pHPT include nepfhrolithiasis, pancreatitis, cardiac arrhytmias, hypertension, nausea and vomiting. pHPT is caused by a solitary adenoma in 85–90% of patients, and the curative treatment is parathyroidectomy. Here, we presented two women who have diagnosed pHPT and operated without complications in pregnancy.

Case 1: She was 20 years old and presented with abdominal pain at 8th weeks gestation. Her laboratory tests were revealed 12.2 mg/dl Ca levels, 2 mg/dl Phosphorous (P) levels and 136 pg/ml parathyroid hormone (PTH) levels and her urine Ca level was 810 mg/24 h. Her neck ultrasonography (US) revealed a hypoechoic lesion with 6.3×6.3×14.5 mm size consistent with parathyroid adenoma in the left superior of the thyroid gland. No thyroid nodule was detected. Nepfhrolithiasis was not determined. The left superior parathyroid gland was excised with minimal invasive surgery in the 9th weeks of gestation and parathyroid adenoma was excised.

Case 2: Thirty-eight years old woman who was 9th weeks gestation was referred to our clinic for the high serum Ca levels. Her Ca level was 11.5 mg/dl, P level was 1.4 mg/dl, PTH level was 344 pg/ml. Her neck US revealed parathyroid adenoma in the right inferior part of the thyroid gland 2×1×1 cm with size. Also she had a nodule in the right thyroid gland. She had underwent right hemithyroidectomy and parathyroidectomy in the second trimester and parathyroid adenoma was excised.

Conclusion: Since the symptoms are often non-specific in the PHPT, it can be easily misdiagnosed during pregnancy. Early recognition of pHPT, followed by appropriate management and treatment may reduce the maternal and fetal complications. Therefore pregnant women with biochemical hypercalcemia or any clinical presentation associated with hypercalcemia must be evaluated for pHPT.