Neonatal hypocalcemic seizures revealing asymptomatic maternal hyperparathyroidism: case report and literature revue

Jaweher Kechiche; Abir Meherzi; Taieb Ach; Mouna Bellakhdher; Ghada Saad; Jihen Houas; Wassin Kermani; El Abed Yosra Hasni; Mohamed Abdelkefi

doi:10.1530/endoabs.110.EP700

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Endocrine Abstracts (2025) 110 EP700 | DOI: 10.1530/endoabs.110.EP700

ECEESPE2025 ePoster Presentations Fetal and Neonatal Endocrinology (27 abstracts)

Neonatal hypocalcemic seizures revealing asymptomatic maternal hyperparathyroidism: case report and literature revue

Jaweher Kechiche ¹ , Abir Meherzi ¹ , Taieb Ach ² , Mouna Bellakhdher ¹ , Ghada Saad ² , Jihen Houas ¹ , Wassin Kermani ¹ , Yosra Hasni El Abed ² & Mohamed Abdelkefi ¹

Author affiliations

¹Farhat Hached University Hospital, ENT Head and Neck Surgery, Sousse, Tunisia; ²Farhat Hached University Hospital, Endocrinology Departement, Sousse, Tunisia

JOINT3475

Introduction: Primary hyperparathyroidism during pregnancy is a rare condition increasing both maternal and perinatal morbidity and mortality. Thus, early detection and prompt surgery are essential, with the optimal timing being during the second trimester, which is considered safe. Maternal hyperparathyroidism can cause severe neonatal hypocalcemia and hypocalcemic tetany, affecting approximately 50% of infants born to mothers with untreated disease. Neonatal hypocalcemia results from prolonged parathyroid suppression due to chronic maternal hypercalcemia and the sudden cessation of maternal calcium transfer after delivery. The aim of this study is to highlight the importance of early diagnosis and management of maternal primary hyperparathyroidism during pregnancy to prevent neonatal complications, particularly hypocalcemic seizures.

Materials and methods: We present a case of recurrent neonatal tonico-clonic seizures due to undiagnosed asymptomatic maternal hyperparathyroidism.

Results: A fifteen-day-old male infant was presented to pediatric emergency department because of recurrent tonico-clonic seizures. Physical examination was normal. Ca level was 1.5 mmol/l, PTH levels was relatively low: 16 pg/mL. Transient hypoparathyroidism was considered as the cause of hypocalcemic seizures. The patient’s mother had no complaints, nor a medical history. Her physical examination was normal. Biochemical evaluation revealed a serum total Ca level of 3,05 mmol/l. Serum phosphate level was 0,38 mmol/l. Urinary Ca was also elevated to 705 mg/24H. The PTH level was found to be 603 pg/mL while 25(OH)D level was low: 25 ng/mL. Parathyroid SPECT was performed with 99m Technetium-MIBI revealing a right inferior parathyroid adenom. Asymptomatic primary hyperparathyroidism was diagnosed and surgery was planned.

Conclusions: Unrecognized maternal hyperparathyroidism can suppresses fetal parathyroid activity and impairs the parathyroid response to hypocalcemia after birth. Based on our review of the literature, surgery is the preferred definitive treatment and is deemed safe and effective when performed during the second trimester of pregnancy.