Endocrine Abstracts

Introduction: Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder in the general population, with a prevalence of 0.1 to 0.4%, caused by a solitary parathyroid adenoma in 80 to 85% of cases. In pregnancy, however, it is rare and usually manifests with non-specific symptoms leading to the delay in diagnosis A 33-year-old female patient who wasreviewed in obstetrics clinic at 15/40 weeks gestation. She complained of body aches, intermitted nausea and vomiting, and feeling generally unwell. She visited her GP who performed blood tests including serum bone and thyroid profiles. This revealed a high adjusted serum calcium of 3.27 millimoles/litre (mmol/l), borderline-low phosphate of 0.79 mmol/l, a high PTH of 9.4 pmol/L, and normal vitamin D level at 83. Thyroid profile showed a free T4 (FT4) level of 35.1 pmol/l and a suppressed thyroid-stimulating hormone (TSH) of less than 0.01 mU/l. 24-hour urine calcium result was elevated at 11.1 millimoles. She was admitted to the hospital and was managed conservatively with IV fluids. She was also started oncarbimazole 5 mg daily. The calcium level improved after IV hydration to 2.88 mmol/l and discharged home. Three weeks later,a repeat blood test showed persistent hypercalcaemia of 2.96 mmol/l andsymptomatic requiring admission for IV hydration. Initial neck ultrasonography was performed and did not show parathyroid adenoma. It did however detect a total of three benign-appearing nodules in both lobes of the thyroid gland. The patient also underwent urinary tract ultrasonography and nephrolithiasis was ruled-out. She had parathyroictomy at 19th week of gestation, after which calcium and PTH levels returned to normal. The patient did not suffer from any post-operative complications.

Discussion: Primary hyperparathyroidism in pregnancy(PHPT) rare and probably underdiagnosed. This is partly due to the large overlap between symptoms of hypercalcaemia and symptoms commonly attributed to pregnancy itself, such as nausea and vomiting. It is necessary to recognise symptoms of hypercalcaemia, when present, during pregnancy and establish the diagnosis of primary hyperparathyroidism to prevent both foetal and maternal complications associated with hypercalcaemia.

Conclusion: Serum bone profile is not routinely performed during pregnancy check-ups; however, we would highly recommend screening for primary hyperparathyroidim in the presence of any symptoms known to be associated with hypercalcaemia. This would lead to early diagnosis Diagnostic and therapeutic options are more limited for PHPT in pregnancy than in the non-pregnant patient. Parathyroidectomy is strongly advised as a first-line curative measure,in the second trimester.