Endocrine Abstracts

Introduction: Primary hyperparathyroidism is the most common cause of hypercalcemia in the general population. Hypercalcemia during pregnancy can result in significant maternal and fetal morbidity and mortality.

Case: A 30-year-old pregnant female primigravida in the 31 weeks of gestation with complaint of obstinate constipation was admitted to our emergency department. In laboratory tests, hypercalcemia was detected. She was a Syrian refugee and was unable to communicate in English and Turkish. The parathyroid hormone (PTH) and albumin-corrected serum calcium levels were high. The results were 203 (12–65) pg/ml and 15.1 (8.5–10.5) mg/dl respectively. Urinary calcium excretion rate was 440 mg/per day. Tubular phosphorus reabsorption rate was 73%, and the chlor/phosphorus ratio was 54.7. In the light of all these data, primary hyperparathyroidism was diagnosed. Ultrasound imaging revealed a parathyroid adenoma (6×6×19 mm) at the inferior of the left thyroid lobe. In our case we started 3000 cc salin infusion and furosemid treatment but her calcium levels didn’t decrease to safe range. Intravenous calcitonin was added to treatment but calcium levels didn’t decrease. We started to hemodialysis but still was calcium level >12.5 mg/dl. We followed up the patient in hospital until the baby’s lung maturation is completed. When the gestation reached the 35th week, parathyroid adenoma excision and caesarean section were performed concurrently. Post-operative calcium levels decreased. Hypocalcemia improved with medical treatment in the newborn.

Discussion: The main treatment modality of hyperparathyroidism is surgery but if hyperparathyroidism is diagnosed in third trimester surgical approaches have high risk. Because of the high risk, we trained our patient with medical treatment at the hospital until safe birth time. In the postpartum interval to avoid a parathyroid crisis, surgery and cesarean operation were performed simultaneously during the safe period for the baby.