Endocrine Abstracts

Introduction: Primary hyperparathyroidism is a disorder, characterized by autonomous overproduction of parathormone resulting in hypercalcemia. The main cause is a parathyroid adenoma. Less common etiologies are parathyroid hyperplasia and carcinoma. Primary hyperparathyroidism during pregnancy is rare and the management could be challenging. Maternal and fetal/neonatal complications occur in more than 50% of the cases.

Patient: We report about a 38-year-old female, who was referred with hypercalcemia for further evaluation. The patient suffered from rheumatoid arthritis treated with prednisolone 2.5 mg/d. She reported no symptoms. Parathormone 12.1 pmol/l (1.6-6.9), albumin adjusted calcium (AAC) 2.59 mmol/l (2.1-2.55), phosphate 0.87 mmol/l (0.8-1.45), calciuria 9.7 mmol/d (<6.2), 25-OH-Vitamin D3 46.8 nmol/l (50-150) and 1.25-OH Vitamin D3 207 pmol/l (47.8-190) showed primary hyperparathyroidism. Ultrasound revealed no enlarged glands. Pregnancy occurred while under investigation. During pregnancy ACC remained stable at 2.7 mmol/l and parathormone at the upper normal range by 6.7 pmol/l. Repeated neck ultrasound during the second trimester was non diagnostic. No maternal or fetal complications occurred. Labor started spontaneous at 43 weeks. One month postpartum the biochemical markers were normalized. Six months after delivery secondary hyperparathyroidism due to vitamin D deficiency was shown.

Conclusion: Spontaneous resolution of primary hyperparathyroidism is rare, but is reported after infarction or hemorrhage of small parathyroid adenomas.