Endocrine Abstracts

Background: Primary hyperparathyroidism (PHPT) in pregnancy is rare and associated with substantial maternal–fetal risk, including miscarriage, nephrolithiasis, acute kidney injury, fetal growth restriction, and neonatal hypocalcaemia. Diagnostic imaging options are restricted, and the second trimester represents the safest window for parathyroidectomy. The UK’s first One Stop PHPT Clinic at Queen Elizabeth Hospital Birmingham was developed to enable accelerated identification and coordinated consultant-led multidisciplinary management of high-risk cases.

Case Summary: A 35-year-old woman, gravida five with four previous miscarriages, was referred with recurrent nephrolithiasis and symptomatic hypercalcaemia. Biochemistry confirmed PHPT, with deterioration over four months, including corrected calcium rising to 3.06 mmol/l and parathyroid hormone (PTH) to 14.4 pmol/l, alongside worsening symptoms. Early pregnancy at six weeks’ gestation was concurrently identified, significantly intensifying maternal–fetal risk and narrowing the window for definitive treatment, which triggered immediate consultant-led review, bypassing routine nurse-led triage. As pregnancy contraindicates nuclear scintigraphy, urgent radiology–endocrine collaboration enabled rapid localisation using neck ultrasound and low-dose 4D CT, identifying a right inferior parathyroid adenoma. At 17+6 weeks’ gestation, the case was reviewed at a combined Parathyroid–Gynaecology–Obstetric multidisciplinary team (MDT) meeting, where second-trimester parathyroidectomy was unanimously recommended. Parathyroidectomy was performed at 22 weeks’ gestation, achieving an intra-operative PTH reduction from 16.1 to 4.06 pmol/l. Post-operative calcium normalised without hypocalcaemia, recovery was uncomplicated, and fetal monitoring remained reassuring. The pregnancy is ongoing and progressing normally.

Learning Outcomes: • To recognise PHPT as a rare but high-risk condition in pregnancy requiring early senior involvement

• To understand imaging limitations in pregnancy and the role of radiology–endocrine collaboration

• To demonstrate how a One Stop PHPT service model and MDT consensus can enable timely localisation and definitive management

Conclusion: A structured One Stop PHPT pathway enables accelerated, consultant-led multidisciplinary care for complex PHPT presentations in pregnancy, supporting favourable maternal and fetal outcomes.