Endocrine Abstracts

Introduction: Hypercalcaemia in pregnancy is an uncommon event that can cause major maternal morbidity and/or foetal morbidity and mortality. We present a case report and discuss management.

Case: A 34-year-old woman was seen initially in endocrinology clinic with primary hyperparathyroidism. A neck ultrasound scan did not identify a parathyroid adenoma, but parathyroid MIBI scan suggested a left inferior parathyroid adenoma. Plasma metanephrines were normal, and a genetic testing ruled out multiple endocrine neoplasia-1. She got pregnant and then reviewed in antenatal clinic with calcium check every 4 weeks. Her case was discussed in a meeting between endocrinologist, obstetrician, and surgeon who agreed on going ahead with parathyroid surgery, which took place at 26 weeks gestation. Postoperative calcium was normal (2.36 mmol/l), PTH was low but normalised a few weeks later. The histology showed parathyroid adenoma, however one of the lymph nodes revealed a 1 mm focus of metastatic papillary thyroid cancer. Thyroid multidisciplinary meeting recommended surveillance. At 39 weeks, she had induction of labour due to reduced foetal movement, and gave birth to a healthy 2415 gram female baby.

Conclusion: Primary Hyperparathyroidism in pregnancy is a threat to mother and child. Medical management may be appropriate in mild disease, but in moderate to severe disease, parathyroidectomy under general anaesthesia in the second trimester is safe.