The prevalence of primary hyperparthyroidism (PT) in the general population is 0.15%. The incidence in pregnancy is unknown; however primary hyperparathyroidism during pregnancy poses significant maternal and fetal complications. Complications to the mother include nephrolithiasis, bone disease and muscle weakness. Fetal complications include fetal loss, intrauterine growth retardation, postpartum neonatal tetany and permanent hypoparathyroidism. The symptoms of PT are similar to pregnancy masking the diagnosis. Cases may be managed conservatively but surgery is indicated if serum calcium cannot be controlled.
This is a case of a 30-year-old AfroCarribean in her first pregnancy presenting with headache, polyuria and polydipsia to the Accident and Emergency Department at 11 weeks gestation. She was otherwise well, with no relevant family history. Examination was unremarkable except for her blood pressure of 160/96 mmHg. Her biochemical profile included; corrected calcium 2.83 mmol/l, phosphate 0.77 mmol/l, urea 2.7 mmol/l, creatinine 73 μmol/L, parathyroid hormone 16.7 pmol/L and vitamin D 19.06 nmol/L and glucose 4.5 mmol/l. The calcium clearance to creatinine clearance ratio was 0.027 and the renal ultrasound was unremarkable. She was initially managed with intravenous normal saline and encouraged to drink 2 litres of fluid daily. However this was unsuccessful in returning her serum calcium to normal. Therefore she underwent exploratory neck surgery at 15 weeks gestation. She was found to have a 0.509 g left lower parathyroid gland. Histology confirmed an adenoma of size 1.4 by 0.9 by 0.5 cm. Post operatively her symptoms and hypertension resolved. Her corrected calcium is 2.26 mmol/l and she continues to have an uneventful pregnancy.
In summary this is a case of PT diagnosed in pregnancy and managed with surgical intervention with complete resolution of all symptoms and signs. This case highlights the need to be aware of the differential diagnosis of polyuria and polydipsia in pregnancy since timely management will lead to a successful outcome.
06 - 07 Nov 2006
Society for Endocrinology