Endocrine Abstracts

A 30-year-old lady was initially seen in our clinic with a slight elevated corrected calcium with an elevated parathyroid hormone in March 2021. The elevated calcium [2.58mmol/l(NR: 2.10-2.55)] was first noted in 2018 when she had investigations for easy bruising, fatigue, breathlessness, and weight loss. The symptoms settled on their own and her calcium levels were monitored routinely. She was referred to our clinic when the corrected calcium had increased to 2.69mmol/lwith an elevated parathyroid hormone (PTH) at 20.7(NR: 1.5-6.9 pmol/l) and vitamin D in deficiency range. Her thyroid function tests were in normal range. She was on sertraline and antihistamines for anxiety and urticaria, respectively. She did not report any history of kidney stones and she has never had any bowel discomfort. Her blood pressure was within normal range. She did not have any significant family medical history. She was started on vitamin D3 1000 units daily, with a plan of measuring the urine calcium creatinine clearance ratio once the vitamin D is in replete range. A renal tract ultrasound and neck ultrasound were also arranged. As she was young, she was referred to clinical genetics for their input. In our clinic in June 2021; her corrected calcium had increased to 2.99mmol/l, PTH:20.8 and vitamin D level:50nmol/l. There were no calculi on the renal tract ultrasound, and she was referred to the ENT for review in consideration of parathyroidectomy. A parathyroid MIBI scan had shown an equivocal result, but the neck ultrasound had shown a 4.3 cm cystic structure which looked to be a parathyroid adenoma. In October 2021, she was seen in our combined endocrine antenatal clinic with a 7-week pregnancy. The risks of primary hyperparathyroidism in pregnancy were discussed and it was decided that she will undergo parathyroid surgery in the second trimester. In December 2021, parathyroidectomy was performed successfully at 17 weeks of pregnancy. In January 2022, her corrected calcium and PTH levels have normalized to 2.38mmol/land 2.1 pmol/lrespectively. The rest of pregnancy was uneventful, and she delivered a healthy baby at term. The results of clinical genetics were not available at the time of writing. It is important to explore fertility plans in young women with primary hyperparathyroidism, to discuss contraception before definitive cure and to remember that parathyroid surgery can be done in the second trimester.