Endocrine Abstracts

Introduction: In pregnancy, the incidence of Primary Hyperparathyroidism is 1%; and there are 80% adenoma, 15% parathyroid hyperplasia, 3% multiple adenoma, and 1% parathyroid carcinoma in its etiology. In pregnancy, serum calcium (Ca) levels may not rise as much as expected. This is associated with hypoalbuminemia, GFR increase, placental Ca transfer, and inhibition of PTH–related bone resorption by estrogen. In pregnancy, hyperparathyroidism is asymptomatic at a rate of 25–80%. In pregnancies that are complicated with primary hyperparathyroidism, 67% maternal and 80% fetal/neonatal complications were reported in previous studies. In this case report, a pregnant patient who was followed-up due to primary hyperparathyroidism has been presented.

Case: A 34-year-old female patient, who had a history of operation in 2013 and 2018 because of nephrolithiasis, was referred to our clinic in January 2019 because of hypercalcemia. The patient had Ca:11.66 mg/dl (8.7–10.4 mg/dl), Pth:163 ng/l (18.4–80.1 ng/l), P:2.74 mg/dl (2.4–5.1 mg/dl), alb: 48 g/l (32–48 g/l). The Ca elimination in 24-hour urine was 131 mg/day. In the USG, Hypoechoic nodular formation was detected outside the left lobe inferior thyroid area (LAP? PARATHYROID ADENOMA?); and there was a finding that was consistent with adenoma in the same localization in the MIBI. The Z score of the patient was consistent with age and gender. In renal USI, 5–mm diameter stone was detected in the right kidney. Hormonal evaluation was made in terms of multiple endocrine neoplasia. Sampling was made for genetics. When the genetic results were expected, it was determined that the patient was pregnant in May 2019. The patient who had Ca: 11 mg/dl (8.7–10.4 mg/dl), alb:41 g/l (32–48 g/l), P: 2.1 mg/dl (2.4–5.1 mg/dl), was admitted to the Endocrine Service on 20/06/2019. The patient was given oral and iv hydration after which it was detected that Ca:9.910.5 mg/dl (D.Ca: 9.9–10.5 mg/dl). Parathyroid adenectomy + left thyroid lobectomy surgery was performed on 16/7/19 while the patient was still pregnant at 23 weeks. Her pathology resulted as Parathyroid Adenoma. After the operation, Ca: 8.8 mg/dl (8.7–10.4 mg/dl), dCa: 9.2 mg/dl, mg: 1.4 mg/dl (1.3–2.7 mg/dl), PTH 26 ng/l (18.4–80.1 ng/l), were detected. When the patient was at 39th week, she gave birth to a 2.500–kg girl with a caesarean section on 20/11/2019.

Conclusion: The decision to medical or surgical treatment of Primary Hyperparathyroidism in pregnant women is based on the evaluation of the risks by the endocrinologist and the obstetrician. The definitive treatment is surgery. Serum Ca: 2.75 mmol/l (11 mg/dl) and/or hypercalcemia is recommended for the treatment of maternal or fetal complications. Surgery is recommended in the 2nd trimester.