Endocrine Abstracts

Abstract: A 32-year-old lady presented to us at 6 months of gestation with parathyroid hormone (PTH) -dependent hypercalcemia mediated pancreatitis and endogenous insulin dependent hypoglycemia, owing to parathyroid adenoma and possibly insulinoma, respectively. The parathyroid adenoma was localized on the MRI of the neck; however, no imaging for the insulinoma could be done due to the gravid state. Due to the simultaneous occurrence of tumors in two endocrine glands, namely, parathyroid gland and pancreatic islet cells, a diagnosis of MEN-1 (Multiple Endocrine Neoplasia) was considered. MEN-1 syndrome is very rarely seen in pregnancy. Owing to this rarity, no guidelines exist on management of MEN-1 during pregnancy. Our index patient was effectively managed with cinacalcet, alcohol ablation of parathyroid adenoma for hypercalcemia and with short and long acting octreotide for hypoglycemia during the antenatal period. She had a full-term LSCS delivery, with no maternal or neonatal complications, except for transient neonatal hypoglycemia. MEN-1 with pregnancy thus poses a diagnostic and therapeutic challenge and our case highlights the role of multimodal medical therapy for successful management.