Abstract
BackgroundThe efficacy and safety of various modes of medical treatment for primary hyperparathyroidism in pregnancy are largely unknown.Case presentationWe report the case of a 34-year-old white woman with primary hyperparathyroidism symptomatic for nephrolithiasis. Her serum calcium was 3.15 mmol/l and parathyroid hormone was 109.0 ng/L. Neck imaging found no pathological parathyroid tissue. Cinacalcet and cholecalciferol were started. She became pregnant 17 months later. The calcimimetic was stopped. During pregnancy, she was admitted for hydration administered intravenously two to three times per week. In her 24th week of pregnancy, cinacalcet was restarted. In her 32nd week, a cesarean section was carried out as planned.ConclusionsOnly three cases of primary hyperparathyroidism in women on cinacalcet therapy in pregnancy have been published in the literature. In the present case, hydration was useful in controlling serum calcium. Cinacalcet therapy helped to control serum calcium.
Highlights
The efficacy and safety of various modes of medical treatment for primary hyperparathyroidism in pregnancy are largely unknown.Case presentation: We report the case of a 34-year-old white woman with primary hyperparathyroidism symptomatic for nephrolithiasis
Only three cases of primary hyperparathyroidism in women on cinacalcet therapy in pregnancy have been published in the literature
Hydration was useful in controlling serum calcium
Summary
Three cases of PHPT in women on cinacalcet therapy in pregnancy have been published in the medical literature. Hydration was useful in controlling S-Ca, and cinacalcet therapy helped to control S-Ca, it was dangerously high. In the present case, evidence for a true benefit of cinacalcet is very weak. Cinacalcet tolerance was very poor, which precluded the administration of higher doses. It remains unclear whether PTH levels in pregnancy were reduced owing to a possible role of placental PTHrP. Abbreviations 99mTc: Technetium-99m; Ca++: Ionized calcium; CT: Computed tomography; FNAB: Fine-needle aspiration biopsy; MEN: Multiple endocrine neoplasia; NaCl: Sodium chloride; PET: Positron emission tomography; PHPT: Primary hyperparathyroidism; PTH: Parathyroid hormone; PTH-FNAB: Fine-needle washing after aspiration biopsy; PTHrP: Parathyroid hormone-related protein; PTx: Parathyroidectomy; S-Ca: Serum calcium; S-P: Serum phosphorous; SPECT-CT: Single-photon emission computed tomography-computed tomography; Tc: Technetium
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