Endocrine Abstracts

Section 1&2: Case history and investigations: Primary hyperparathyroidism is a rare condition in pregnancy. The occurrence rate is about 1 % and up to 80 % of the patients are asymptomatic. Clinical symptoms are nonspecific. However, severe maternal, foetal and neonatal complications including neonatal death have been reported in literature. 27 years old Asian lady presented to Emergency Department with abdominal pain in July 2019. She was found to have raised calcium at level of 2.8 mmol/l (2.20– 2.60) with a phosphate level of 0.64 mmol/l (0.81–1.45). Adequate hydration was advised with a referral to endocrine outpatient clinic. She was next seen in obstetric clinic three months later with significant weight loss and persistent hyperemesis. She was 13 weeks pregnant at that time and also complained of abdominal discomfort. Her biochemical markers revealed raised calcium of 3.13 mmol/l with phosphate of 0.71 mmol/l. Her PTH was elevated 16.4 pmol/l (1.6–6.9), vitamin D 29 nmol/l and 24 h urine calcium creatinine ratio was 0.039. Parathyroid ultrasound showed right sided parathyroid adenoma. MRI neck as a confirmatory imaging further confirmed 4×6×20 mm right sided adenoma. Her renal and thyroid functions were normal.

Section 3: Results and treatment: Despite of adequate hydration her serum calcium remained persistently raised above 3.00 mmol/l therefore she underwent parathyroid surgery during the second trimester at 22 weeks. Her calcium levels completely normalised post operatively 2.24 mmol/l with normalising PTH 0.4 pmol/l. Histology confirmed benign parathyroid adenoma. There have been no operative, maternal or foetal complications. She is currently 30 weeks into pregnancy and will be followed up next in the endocrine clinic for MEN genetic testing.

Section 4: Conclusion: Symptoms of primary hyperparathyroidism can often occur in normal pregnancy which can lead to diagnostic challenges. Severe maternal complications like hypercalcaemic crisis, pre-eclampsia, nephrolithiasis, pancreatitis, hyperemesis gravidarum might be the first manifestation of primary hyperparathyroidism and its prevalence can be as high as 67% in untreated cases. Weight loss is a rare first manifestation and reported only in few cases in literature so far.