Endocrine Abstracts

We report an interesting case of a rare presentation of hypercalcemia in a 27-year-old pregnant woman with history of Uterine fibroids. The patient arrived at the emergency department with two weeks history of worsening lower abdominal pain. She had resorted to sleeping in a sitting position due to the intensity of pain. There was no vaginal bleeding and bowels were not opened for four days. Physical examination revealed dehydration, tenderness in the lower abdomen with an abdomen larger than expected for her gestational age of 14 weeks. Investigations revealed a calcium level of 3.01 mmom/l with normal kidney function. PTH was suppressed, and vitamin D was low. A subsequent renal ultrasound exhibited no significant abnormalities. Unfortunately assays for PTHrP and 1,25 (OH) Vitamin D were not available for testing. Treatment continued with intravenous hydration. Initial low radiation imaging studies with a chest x-ray and a neck ultrasound demonstrated no remarkable findings prompting the decision for to proceed with an abdominal and pelvic MRI. The MRI revealed a large necrotic uterine mass, likely to represent a fibroid with moderate volume ascites. Following discussion in the MDT, she underwent laparotomy, open myomectomy and partial subcolic omentectomy at 15 weeks of gestation. A 30 cm pedunculated fibroid was successfully, excised and sent for histopathology. Cytology of peritoneal fluid revealed no malignant cells but a full histopathology report is awaited. Calcium levels rapidly normalized post-surgery accompanied by a rise in PTH. Sadly, three days after surgery, the patient had a miscarriage despite calcium remaining within the normal range. Plans are in place to review the patient in clinic with repeat calcium, PTH and cross-sectional imaging. We suspect this is a case of PTHrP mediated hypercalcaemia from uterine fibroid. While such occurrences are extremely rare, they are documented in the literature.