ECEESPE2025 ePoster Presentations Reproductive and Developmental Endocrinology (128 abstracts)
Challenges in managing persistent hypercalcemia during pregnancy after failed surgical intervention: a multidisciplinary approach?
Roshan Shrestha 1 , Lina Eltayieb 1 , Ayesha Awan 1 , Dalya Sadulah 1 , Bashir Mahamud 1 , Edward Lau 1 , Furhana Hussein 1 , Suzane Cadiz 1 , Naing Myo Aung 1 , Abisha Rameshkumar 1 , Bhavini Bhatt 1 , Chineze Otigbah 1 , Min Sun 1 & Gideon Mlawa 1
1Barking, Havering And Redbridge University Hospitals Nhs Trust, Endocrinology and Diabetes, London, United Kingdom.
JOINT3830
Introduction: Hypercalcemia in pregnancy is a rare but significant condition with potential maternal and fetal complications, including nephrolithiasis, preeclampsia, and intrauterine growth restriction. Primary hyperparathyroidism, often caused by a parathyroid adenoma, is the most common etiology. However, its management is challenging due to imaging limitations and concerns about fetal safety. While parathyroidectomy is the definitive treatment, surgical timing must be carefully considered. Cinacalcet is an alternative, though its safety and efficacy in pregnancy remain uncertain. This case highlights the challaenges of managing refractory hypercalcemia in pregnancy, emphasizing the role of a multidisciplinary team (MDT).
Case: A 42-year-old female was referred at 20 weeks of pregnancy due to cognitive impairment, chronic bone pain, fatigue, nausea, polyuria, and polydipsia. She had a history of hypercalcemia (corrected calcium 2.72–2.84 mmol/l)for 1–2 years, with investigations confirming primary hyperparathyroidism. Ultrasound revealed a 2.4 cm left parathyroid mass. She was started on cinacalcet but discontinued due to intolerance. Following MDT discussions, she underwent parathyroidectomy at 28 weeks, but postoperative calcium remained elevated (2.79 mmol/l)with unsuppressed PTH, indicating persistent disease. During pregnancy, from 32 weeks onward, she received weekly IV fluids and had regular calcium levels monitoring. She delivered via caesarean section, with the baby being small for gestational age. Postpartum imaging raised concerns about residual parathyroid tissue. Histology confirmed parathyroid tissue but lacked definitive evidence of an adenoma. A Sestamibi scan later suggested a large left inferior adenoma, though ultrasound findings were inconclusive. Cinacalcet was poorly tolerated, leading to gastrointestinal complications for which extensive investigations were done, which ruled out sinister pathology. Following MDT discussions, she was re-referred for surgical consideration and currently remains under endocrine team for follow-up of persistent hypercalcemia.
Discussion: Limited imaging options during pregnancy and incomplete surgical resection led to persistent disease. Medical therapy with cinacalcet was ineffective due to intolerance. Despite the attempted medical management and emergency parathyroidectomy, persistent hypercalcemia required ongoing MDT discussions. This case emphasizes the importance of individualized treatment plans and the complexities of managing refractory hyperparathyroidism in pregnancy.
Conclusion: This patient did not achieve normocalcemia and remained in borderline high calcium level despite the surgical intervention and was subsequently managed conservatively with medical therapy and close monitoring. MDT approach was required for further management and follow up to assess biochemical stability and to prevent further complications. The case highlights the need for careful MDT coordination to balance medical vs surgical management.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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