Endocrine Abstracts

Primary hyperparathyroidism is a fairly common endocrine problem affecting women twice as common as men. The first case of primary hyperparathyroidism in pregnancy was reported in 1931. We present a case of a 29 years old lady who was referred to the endocrine clinic from inpatient admission for her high corrected calcium (Corr Ca) levels (3.27 mmol/mol) and high Parathyroid Hormone (PTH) levels (58.9 pmol/l), while she was 12 weeks pregnant. Her past medical history was significant for previous still birth at 25 weeks and depression. Her first serum calcium levels were done by her GP six months after she delivered a dead fetus at 25 weeks gestation. She complained of persistent tiredness and increased thirst, but denied polyuria. She also had ill-defined abdominal pain, and complained of low mood for which she was on Citalopram. Investigations done in endocrine clinic showed Corr Ca: 3.42 mmol/mol, PTH: 54.4 pmol/l and 25 OH Vitamin D level of 27.1 nmol/l. Free T4, IGF-1 and serum cortisol were all in normal range. LH (0.65 IU/l) and FSH (<0.05 IU/l) were keeping in view with the pregnant state. Parathyroid Ultrasound did not reveal any adenoma. 24 hour urinary calcium was 12.4 mmol/24 hours. She was referred to a tertiary center for urgent parathyroidectomy. After parathyroidectemy her PTH normalized to 4.42 pmol/L and Corr Ca to 2.58 mmol/mol. She progressed well with her pregnancy after parathyoiroidectectomy and delivered a healthy baby girl at full term. Serum calcium could be considered as a routine investigation in pregnancy, as appropriate treatment of primary hyperparathyroidism could result in avoidance of high incidence of fetal and maternal complications associated with the condition. Hyperparathyroidism should be suspected in females who present with depression.