Endocrine Abstracts

Background: As primary hyperparathyroidism during pregnancy can pose serious maternal (hypercalcaemic crisis, acute pancreatitis, preeclampsia) and foetal (miscarriage, preterm labour, neonatal tetany) complications, early diagnosis and management are essential. We report two patients with primary hyperparathyroidism during pregnancy.

Case reports: Case 1: A 30-year-old woman was diagnosed with primary hyperparathyroidism during investigations for subfertility in 2020. She underwent right superior parathyroidectomy (histology: parathyroid adenoma) and right inferior parathyroidectomy (histology: normal parathyroid tissue) in 2022. She remained hypercalcaemic postoperatively and conceived while awaiting genetic testing and further surgery. Despite receiving intravenous hydration throughout early pregnancy, her albumin-adjusted calcium levels remained consistently above 2.9mmol/l and she underwent a left superior parathyroidectomy (histology: parathyroid hyperplasia) during the second trimester. Her genetic testing confirmed the diagnosis of multiple endocrine neoplasia type 1. Case 2: A 32-year-old woman was referred for symptomatic hypercalcaemia at eight weeks gestation. Investigations confirmed primary hyperparathyroidism with an albumin-adjusted calcium of 2.71mmol/l subsequently increasing to 3mmol/l despite intravenous hydration. Ultrasound parathyroid confirmed right parathyroid adenoma and she underwent right en-bloc parathyroidectomy (histology: parathyroid adenoma) and hemithyroidectomy. The genetic screening was negative and she remained eucalcaemic post-operatively.

Discussion: Management of primary hyperparathyroidism in pregnancy depends on severity of hypercalcaemia, gestational age, and maternal and foetal status. Parathyroidectomy during second trimester as definitive treatment is advised if the patient has moderate to severe hypercalcaemia. If primary hyperparathyroidism is diagnosed prior to pregnancy, preconception counselling, genetic screening, and parathyroid surgery before conception is advised.

Conclusion: These cases underpin the complexities associated with managing primary hyperparathyroidism during pregnancy. Proactive management can optimise both maternal and foetal outcomes.