Primary hyperparathyroidism (PHP) during pregnancy is a very rare event that increases maternal and fetal morbidity and mortality. Complications during pregnancy or neonatal period have included spontaneous abortion, stillbirth, neonatal death, neonatal tetany.
Management of maternal PHP diagnosed during pregnancy should be based on the patients symptoms and severity of the disease. Hyperparathyroidism characterized by progressive symptoms should be treated surgically, preferably during the second trimester as in the case reported here. A 27-year-old woman was admitted to our clinic at four weeks of gestation with the complaints such as nausea, vomiting and dyspeptic symptoms. One week before, routine biochemical analysis revealed elevated serum calcium level of 13.3 mg/dl and was referred to our clinic. On admission biochemical tests were as follow: Serum calcium 13.7 mg/dl, phosphorus 2.2 mg/dl, albumin 3.6 gr/dl, PTH 109 pg/ml. Ultrasonography of the neck showed a parathyroid adenoma of 1.2×0.5 cm size, in the neighborhood of the inferior pole of the left thyroid lobe. Ultrasonography guided washout was carried out from the suspected adenoma and PTH was measured >5000 pg/ml within the nodule. After treatment with isotonic sodium chloride, serum calcium dropped to 12 mg/dl and the adenoma was excised in second trimester of the gestation. The postoperative course was uncomplicated. At the discharge from the hospital the patients serum calcium level was 9 mg/dl. Still she has a healthy ongoing pregnancy.
Hyperthyroidism should be considered and the serum calcium level measured in a pregnant woman who has resistant nausea and vomiting. This condition can be misdiagnosed as hyperemesis gravidarum and underlying disease may be missed. When PHP is discovered during pregnancy, management depends on the degree of the hypercalcemia, gestational age, and presence of complications. Available evidence suggests that the typical mildly hypercalcemic and asymptomatic pregnant woman with PHP can be safely managed conservatively provided neonatal hypocalcemia is sought for and treated. Otherwise, treatment should be surgery preferably in the second trimester of the pregnancy.