Endocrine Abstracts

JOINT3718

Introduction: Hypercalcemia during pregnancy, while uncommon, is not exceedingly rare. The management of hypercalcemia in pregnancy can be particularly challenging with the approach largely depending on the trimester in which the condition is diagnosed. Treatment strategies include conservative management, medical therapy, or, in some cases, surgical intervention.

Case: A 30-year-old woman was reviewed in the antenatal clinic at 12 weeks of gestation, with blood tests revealing hypercalcemia. Her calcium level was 2.89 mmol/l, parathyroid hormone (PTH) level was elevated at 8.24 pg/ml, urinary calcium was 9.1 mg/24h, and vitamin D level was 58 nmol/L. She was asymptomatic at the time. An ultrasound of the parathyroid glands revealed a left superior parathyroid adenoma. She was referred to the surgical team for consideration of surgery. While awaiting surgical intervention, she was advised to increase her oral fluid intake. Due to delays in the surgical consultation during the second trimester, she was initiated on Cinacalcet therapy. However, she later developed polyhydramnios, prompting an urgent and successful parathyroidectomy at 30 weeks of gestation. Following the surgery, her calcium level normalized to 2.33 mmol/l. She subsequently delivered a healthy baby without complications.

Discussion: Hypercalcemia can be caused by a variety of conditions including primary hyperparathyroidism, malignancy, sarcoidosis, and certain medications. In pregnancy, primary hyperparathyroidism is the most common cause, and the management of hypercalcemia is contingent upon the trimester in which the diagnosis is made. Treatment options may include conservative measures such as intravenous fluids, medical therapies like Calcitonin or Cinacalcet, and surgical intervention. Surgical treatment is generally recommended in the second trimester to prevent both maternal and foetal complications. In cases of symptomatic hypercalcemia, surgical intervention may be indicated later than the 2^nd trimester as seen in this case.

Conclusion: Surgical intervention for hypercalcemia during pregnancy is typically recommended in the second trimester. However, surgery may be necessary in the third trimester, particularly in cases of symptomatic hypercalcemia. In this case, the patient developed polyhydramnios, likely secondary to hypercalcemia, and parathyroidectomy was performed at 30 weeks of gestation which helped manage symptoms and prevented further foetal complications and resulted in an uncomplicated delivery of baby.