Abstract
Diagnosing and treating hypercalcemia during pregnancy can be challenging due to both the physiological changes in calcium homeostasis and the underlying cause for the hypercalcemia. During pregnancy and lactation there is increased mobilization of calcium in the mother to meet the fetus’ calcium requirements. Here we discuss the diagnostic challenges, management, and patient perspective of hypercalcemia during pregnancy in two particular cases and in other rare conditions causing hypercalcemia.
Highlights
Hypercalcemia in pregnancy is rare and in >90% of cases caused by a newly diagnosed primary hyperparathyroidism (PHPT)
Diagnosing hypercalcemia is challenging during pregnancy, as symptoms such as fatigue or nausea mimic those in early pregnancy
Longstanding hypercalcemia might induce nephrolithiasis, pancreatitis, and preeclampsia in the mother [1]. The occurrence of these diseases during pregnancy should push the physicians to screen for hypercalcemia
Summary
Hypercalcemia in pregnancy is rare and in >90% of cases caused by a newly diagnosed primary hyperparathyroidism (PHPT). A 38-year-old female was diagnosed with PHPT at a nonuniversity hospital, based on a modest hypercalcemia, and elevated PTH of 9.2 pmol/L and high to normal urinary calcium excretion of 8.5 g/L and calcium-to-creatinine clearance above 0.02. Despite her young age, it was decided not to perform PTX because of an increased risk for venous thromboembolism and obesity. During that time serum calcium had increased from 2.63 mmol/L to 2.83 mmol/L with a nonsuppressed PTH of 3.8 pmol/L The patient and her partner were counseled by a team consisting of endocrinologists, anesthesiologists, endocrine surgeons, pediatricians, and obstetricians. She was very satisfied with the care given
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