Endocrine Abstracts

Introduction

Parathyroid diseases are infrequent during pregnancy, but produce significant perinatal morbidity and maternal mortality if not diagnosed and properly managed. Primary hyperparathyroidism (PHP) is a rare disease in women of childbearing age. The incidence of the disease is unknown, but it is certainly rare, and most of the reported cases have been simple supplemented by a review of the literature.

Case presentation

We report the case of a 34 year old woman, G4P0 (03 caesarean section), pregnant at 19 weeks of amenorrhea, presents to the consultation for asthenia and a polyuro-polydipsic syndrome accompanied by muscle weakness. Biological data show hypercalcemia at 112 mg/l (81–104), hypophosphoremia at 22 mg/l (25–48), PTH 163 pg/ml (15–65) compared to a normal vitamin D with hypercalciuria at 922 mg/kg/24 h (100–300). Cervical ultrasound reveals a homogeneous highly hypoenogenic left lobar formation of irregular contours measuring 10.2 × 9.7 × 12.5 mm consistent with a parathyroid adenoma, with thyroid gland and left parathyroid lodge without abnormality. These data are therefore in favour of primary hyperparathyroidism on parathyroid adenoma. Abdomino-pelvic ultrasound: no visible lithiase, unpasceded excretory cavities. The patient benefits at 20 weeks of amenorrhea from the surgical exenosia of the left parathyroid adenoma under complicated local anesthesia of a left recurrent paralysis, anatomopathological analysis in favor of a parathyroid adenoma. Calcemia normalizes rapidly after surgery, and the patient gives birth without complication at 39 weeks of amenorrhea.

Discussion

The prevalence of primary hyperparathyroidism during pregnancy is unknown. Etiology is in 85% of reported cases, a unique parathyroid adenoma. Diagnosis is difficult due to physiological changes in pregnancy that can mask the clinical and biological symptoms of hypercalcemia (digestive disorders, hemodlution, hypoememia). Surgical exeresis is usually proposed in the second trimester of pregnancy when calcemia is greater than 2.75 mmol/l despite medical treatment, and represents an acceptable therapeutic solution as evidenced by favourable clinical-biological evolution of the mother and fetus without major complications due to surgery.

Conclusion

Primary hyperparathyroidism during pregnancy is rare, but needs to be researched in the face of a clinical presentation associated with hypercalcemia, in order to rapidly establish appropriate treatment, and reduce the risk of maternal and fetal complications