Primary hyperparathyroidism in pregnancy is reported as being rare rare. It can be associated with significant complications. Maternal complications include symptomatic hypercalcaemia, renal calculi, hyperemesis, muscle weakness, and pre-eclampsia. Fetal complications include IUGR, low birth weight, preterm delivery, intrauterine death, neonatal tetany and fits.
Patient 1 presented with asthma and was found to have primary hyperparathyroidism, corrected calcium 2.72 mmol/l, PTH 67 ng/l. US neck failed to demonstrate a parathyroid lesion. Prior to having a sestamibi scan she became pregnant. Complications of hyperparathyroidism were discussed with her, but she declined surgical intervention and was managed conservatively. Growth scans showed no evidence of IUGR and the mother remained well also. Calcium remained stable at 2.74 mmol/l. She decided to have a home delivery and there were no complications for her or the baby reported in the post partum period.
Patient 2 presented to a local hospital with tiredness, lethargy and polyuria. Corrected calcium was 2.87 mmol/l, PTH 135 ng/l. Investigations suggested a parathyroid lesion on the left side and she underwent bilateral neck exploration. Subsequent histology demonstrated normal parathyroid tissue. She was referred to our unit with persistent hypercalcaemia. Neck US suggested an intrathyroidal parathyroid adenoma but sestamibi was negative. At her next appointment she was 12 weeks pregnant, and calcium was 2.9 mmol/l. It was decided to offer surgery during the second trimester. Initially the intrathyroidal lesion was removed, but intraoperative PTH did not fall. Neck exploration revealed a right superior parathyroid lesion and this was removed with a subsequent fall in PTH concentration. Histology reported a parathyroid adenoma. Calcium remained normal at 2.2 mmol/l without any supplementation for the rest of the pregnancy. The baby was well and was delivered at term.
Conclusion: Both our patients did well, with healthy babies being delivered. Case 2 demonstrates the usefulness of intraoperative PTH measurements during difficult operations. We note that both patients are young and familial conditions need to be excluded.