Primary hyperparathyroidism in pregnancy-a rare cause of life-threatening hypercalcemia: case report and literature review

Abstract

Objective. To report a case of primary hyperparathyroidism in a pregnant patient, report the obstetric and neonatal outcomes, and review the relevant literature. Results. A 29-year-old primigravida was successfully treated for PHP with minimally invasive resection of a parathyroid adenoma in the second trimester of pregnancy. A healthy baby girl was delivered at 37-week gestation with an unremarkable neonatal course. To the best of our knowledge, this is the second case report in the literature utilizing intraoperative PTH during a parathyroidectomy in a pregnant woman. Conclusions. Primary hyperparathyroidism is a rare life-threatening condition that can present during pregnancy. The diagnosis can be difficult to establish during pregnancy, given the nonspecific symptoms related to hypercalcemia. However, a better understanding of the condition, improved diagnostic studies, and well-organized multidisciplinary management decisions can significantly reduce the morbidity and mortality associated with the disease during pregnancy. This case report is presented to highlight the value of early diagnosis and appropriate management of PHP during pregnancy.

Figure 1

Ultrasound image demonstrates a hypoechoic mass, 1.9 × 0.4 × 1 cm, inferior and posterior to the right lobe of the thyroid, consistent an enlarged right inferior parathyroid gland.

Figure 2

H&E staining; magnification ×40; demonstrates a parathyroid adenoma composed of chief cells with some oxyphil cells in a delicate capillary network.