Endocrine Abstracts

Introduction: Hypercalcemic crisis is a rare therapeutic emergency, but one that should not be overlooked, particularly during pregnancy, when it is associated with significant maternal-fetal morbidity. The most frequent etiology is PHPT, including during pregnancy.

Observation: We report the case of a 34-year-old patient with no particular pathological history, pregnant at 34 weeks of amenorrhea, who presented with acute cholecystitis. The blood test showed malignant hypercalcemia at 3.56 mmol/l, hypophosphatemia and elevated PTH at 30.7 pg/l (1.9-8.5). Good fetal vitality but IUGR. We started with hydration, and after discussion with the gynecologists, we decided not to start FUROSEMIDE because of the risk of placental hypo-perfusion and worsening of the IUGR. Cervical ultrasound revealed a 7 mm parathyroid adenoma. Given the relative contraindication to bisphosphonates and calcinomimetics, and after a collegial decision, we requested a F-choline PET scan, which was concordant with the ultrasound. We had a choice between either minimally invasive surgery under local anaesthetic and parahyroidectomy with acouhement at term, or Caesarean section, extraction of the baby and subsequent conventional parathyroid surgery. In the end, we opted for the first solution, given the baby’s IUGR. methoxylated derivatives of catecholamines are negative in the NEM2 hypothesis. Following the operation, blood calcium and PTH levels returned to normal.

Conclusion: Hypercalcemic crisis is rare, particularly during pregnancy, and is responsible for high maternal-fetal morbidity: miscarriage, IUGR. The etiological and therapeutic management during pregnancy is complex, and there are few recommendations. A multidisciplinary approach is required.