Endocrine Abstracts

Background: Hypercalcaemia in pregnancy is rare, with potential adverse obstetric and perinatal outcomes. It is often difficult to detect as patients can be relatively asymptomatic, and serum calcium is infrequently measured routinely during pregnancy. Diagnosing the cause is made more complex by changes in calcium metabolism during pregnancy. We present a rare case of hypercalcaemia in pregnancy not related to primary hyperparathyroidism and how an orchestrated multidisciplinary approach ensured the optimal care for mother and baby.

Case Presentation: A 38-year old lady, G1P0, 27 weeks pregnant, and with background of gestational diabetes, was referred to Endocrinology with serum calcium of 2.79 mmol/l, was performed in view of painful wrist. Serial serum calcium levels remained elevated, and parathyroid hormone levels were at low normal limit. Other investigations revealed adequate vitamin D, normal phosphate, thyroid, renal and liver functions. A 24-h urine calcium was normal at 5.3 mmol/24h (range 2.5 – 7.5). To complicate things, she had a palpable axillary lymph node but ultrasound/FNA came back reassuringly benign. The hypercalcaemia was felt to be placental-driven and a multidisciplinary care plan was set up. She was encouraged to have adequate daily hydration and avoid any calcium-containing agents. She had close monitoring of serum calcium. She was seen by maternal medicine team in addition to her Obstetricians. Neonatal team was pre-informed and involved for the delivery. She was thoroughly educated of the condition, potential risks and care plan. She had an uneventful delivery with the support of multidisciplinary team, and both mother and baby had normal calcium levels on monitoring.

Learning Point: This case highlights the importance of a well-planned multidisciplinary approach to ensure safety of mother and baby in rare cases of hypercalcaemia in pregnancy. It is also important to ensure mother is well-supported and educated of the condition and potential risk.