Primary Hyperparathyroidism in Pregnancy: A Case Report

Abstract

Primary hyperparathyroidism during pregnancy is a rare disorder. When managed inappropriately, it is associated with significant maternal and fetal morbidity. We present a pregnant woman who presented with hypercalcemia, hyperparathyroidism, and lower leg pain at 34 weeks' gestation. Radiography revealed multiple osteosclerotic nodules of the skull, subperiosteal resorption over the metacarpal bone, and pubic bone fracture. Primary hyperparathyroidism due to parathyroid adenoma was impressed. Normal saline and magnesium sulfate was administered, but was ineffective in controlling the hypercalcemia. At 35 weeks gestation, she delivered a health baby. However, the infant developed transient hypocalcemia 12 hours postpratum. After calcium supplement, the infant recovered well and was discharged 2 weeks pospartum. Postpartum parathyroid scan of the mother revealed radiotracer accumulation at the inferior right parathyroid level. She underwent parathyroidectomy at 3 weeks post delivery, which confirmed the presence of parathyroid adenoma. In conclusion, in cases of primary hyperparathyroidism during pregnancy, poor response to medical therapy may necessitate parathyroidectomy, even in third trimester. Neonatal hypocalcemia should be close monitored and prevented. The possibility of primary hyperparathyroidism should be considered in pregnant patients presenting with hypercalcemia, nephrolithiasis, or idiopathic bone fracture.