Introduction: Hyperparathyroidism in pregnancy is rare and is associated with significant maternal and fetal morbidity and mortality. Recognition can be challenging due to the inability to differentiate hypercalcaemia symptoms from those of pregnancy, studies suggest that up to 80% of cases may be undiagnosed. We report three cases of hyperparathyroidism in pregnancy at Royal Derby Hospital, investigations (Table 1) and management in these patients are reviewed.
Case 1: 29 year old, 36 weeks pregnant (36/40) referred to endocrine clinic with incidental hypercalcaemia; diagnosed as hyperparathyroidism with low vitamin D. Vitamin D was replaced and calcium levels controlled with fluids. Post pregnancy, ultrasound neck revealed evidence of likely right inferior parathyroid adenoma and neck exploration surgery was scheduled.
Case 2: 27 year old, 10/40 diagnosed with hypercalcaemia secondary to hyperparathyroidism. This was regularly monitored throughout pregnancy, controlled with oral fluid intake and calcium did not exceed 2.86 mmol/l. A left inferior parathyroid adenoma was excised post-partum, histology revealed this to be benign and calcium levels normalised post operatively.
Case 3: 20 year old, incidental finding of hypercalcaemia at 24/40. Ultrasound neck revealed no evidence of parathyroid adenoma. Emergency caesarean section was required at 32/40 due to persistent hypercalcaemia (3.27 mmol/l) despite treatment with Cinnacalcet and Calcitonin.
|Investigation at presentation||Case 1||Case 2||Case 3|
|Corrected Calcium (mmol/l)||2.98||2.74||3.10|
|Parathyroid Hormone (ng/l)||32||52||54|
|Vitamin D (nmol/l)||54||71||30|
|PTH-Related Peptide (pmol/l)||1.4||||5.0|
|Calcium Excretion Index (<15 suggests FHH)||46||24||90|
Conclusion: Hyperparathyroidism during pregnancy is associated with suppression of neonatal parathyroid hormone and therefore risks severe neonatal hypocalcaemia, with a reported 30% mortality rate. It is therefore imperative to efficiently investigate and optimise management of hyperparathyroidism during pregnancy as in the cases described in order to minimise maternal and fetal complications.