Endocrine Abstracts

Introduction: Despite its rarity, the most common cause of hypercalcemia in pregnancy is primary hyperparathyroidism (PHPT). This disorder increases the risk of miscarriages, premature birth, intrauterine growth restriction, severe pancreatitis, preeclampsia, and neonatal hypocalcaemic tetany if not diagnosed and properly managed.

Case: A 31-year-old woman with 13 weeks of pregnancy and acute pancreatitis was admitted to the Obstetrics department. Since the 6th week of pregnancy, she has suffered from intense nausea, vomiting, and great general weakness. To find the cause of acute pancreatitis, the calcium level was measured, and severe hypercalcemia albumin-corrected at 3.5 mmol/l was found. Hypophosphatemia 0.61 mmol/l, hypomagnesemia 0.36 mmol/l, hypokalemia 2.27 mmol/l, anemia Hb 89 g/l, parathyroid hormone (PTH) 32.37 pmol/l, vitamin D 74.5 nmol/l, normal renal function, and hypercalciuria in 24-h urine at 15.42 mmol/l are also found in the laboratory. Abdominal-pelvic ultrasound revealed no kidney calcification and confirmed no abnormalities in the fetus. A neck ultrasound revealed a 3.1×1.1×2.4 cm hypoechogenic mass under the left thyroid lobe, which looked more like an enlarged lymph node than a parathyroid gland, so the mass was aspirated with a fine needle. From the start of the hospitalization and while waiting for the puncture results, a large amount of infusion therapy was administered, lowering the calcium level to 2.8 mmol/l. Other electrolyte imbalances were also corrected. Cytology results confirmed a parathyroid gland, and a parathyroidectomy was performed in the 15th week of pregnancy. After surgery, PTH was 0.61 mmol/l, and the lowest albumin-corrected calcium level was 2.2 mmol/l on the 4th day after surgery. Calcium, magnesium, and vitamin D supplements were administered to prevent the symptoms of hypocalcemia. The patient complained of mild numbness in her arms for two days following surgery. The calcium level normalizes rapidly after surgery, and the mother and fetus were both in good health when the patient was released from the hospital for follow-up care. Postoperative pathology suggested a parathyroid adenoma.

Conclusions: The diagnosis of PHPT in pregnancy is difficult due to the physiological changes in pregnancy that can mask the clinical symptoms of hypercalcemia. When pregnant women have intensive digestive disorders, fatigue, polyuria, and muscle weakness, calcium levels should be measured to rapidly establish appropriate treatment and reduce the risk of maternal and fetal complications. Surgery is the first choice of PHPT treatment and it is the safest during the second trimester of pregnancy.