Endocrine Abstracts

Primary hyperparathyroidism (PHP) is the most common aetiology for hypercalcaemia. Its prevalence in pregnancy is reported to be between 0.15% and 1.4%[i][ii]. It presents a threat to the health of both mother (hyperemesis, nephrolithiasis) and foetus (foetal death, congenital malformations, neonatal severe hypocalcaemia induced tetany)[iii][iv]. However, there is a lack of clear guidance on management of primary hyperparathyroidism in pregnancy. We describe the case of a 26 year old female patient who presented with severe hypercalcaemia secondary to primary hyperparathyroidism and underwent successful parathyroid adenectomy under local anaesthesia. Our case report highlights the following relevant learning points:

1. The prevalence of primary hyperparathyroidism is reported to be low at < 1.4%.

2. There is a perceived risk of general anaesthesia to the pregnancy in the first trimester, pushing general consensus to delaying surgery to second trimester when possible

3. Imaging such as parathyroid USS and SPECT CT + Sestamibi scan Tc99m can help localise the culpable adenoma with minimal radiation to the mother and patient

4. If the patient presents with severe or symptomatic hypercalcaemia, minimally invasive surgery under local anaesthetic would be the treatment of choice regardless of the gestational age of the pregnancy.

[i] Malekar-Raikar S, Sinnott BP. Primary hyperparathyroidism in pregnancy–a rare cause of life-threatening hypercalcemia: case report and literature review. Case reports in endocrinology. 2011 Jul 18;2011. [ii] Heath III H, Hodgson SF, Kennedy MA. Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community. New England Journal of Medicine. 1980 Jan 24;302(4):189-93. [iii] Sharma SG, Levine SN, Yatavelli RK, Shaha MA, Nathan CA. Parathyroidectomy in first trimester of pregnancy. Journal of the Endocrine Society. 2020 Mar;4(3):bvaa015. [iv] Kelly TR. Primary hyperparathyroidism during pregnancy. Surgery. 1991 Dec 1;110(6):1028-34.