A Case of Pregnancy Complicated by Primary Hyperparathyroidism Due to a Parathyroid Adenoma

Abstract

BACKGROUND Primary hyperparathyroidism is most common in women during the menopause and its occurrence in pregnant women is rare. However, because neonatal mortality is associated with maternal hyperparathyroidism, early diagnosis is essential. This report describes the case of a late diagnosis of primary hyperparathyroidism in a 28-year-old pregnant woman and describes the effects on the mother and neonate. CASE REPORT During her second pregnancy, a 28-year-old woman presented with symptoms of general weakness, bone and joint pain, multiple fractures with bone deformity, muscle weakness, and gait disturbance. Due to the high risk of perinatal pathology, a cesarean section was performed. Several weeks later, she underwent thoracoscopic removal of an ectopic parathyroid gland located at the aortic arch. Hypocalcemia in the newborn infant required treatment with calcium and magnesium supplements. CONCLUSIONS This case demonstrates that primary hyperparathyroidism during pregnancy requires timely diagnosis and treatment to reduce potential maternal and fetal complications. Screening for primary hyperparathyroidism should be undertaken in pregnant women with any symptoms associated with hypercalcemia. Treatment should be individualized and includes conservative management, parathyroidectomy in the second trimester, or parathyroidectomy performed in the early postpartum period.

Figure 1.

A case of pregnancy complicated by primary hyperparathyroidism: Macroscopic and X-ray images of the vertebrae. (A) The appearance of the 28-year-old woman before surgery showing the thoracic and lumbar spine deformity. (B) X-ray image of vertebral compression of T8–T10 and L2–L4. (C) X-ray image of vertebral compression of L5.

Figure 2.

A case of pregnancy complicated by primary hyperparathyroidism: Macroscopic and X-ray images of the wrist and hands. (A) The deformed image of the wrist and fingers of the hand. (B) X-ray image of the deformed distal tubular bones, showing acro-osteolysis, or subperiosteal resorption of the distal phalanges.

Figure 3.

A case of pregnancy complicated by primary hyperparathyroidism: Contrast-enhanced computed tomography (CT) images of the ectopic parathyroid gland. (A) Contrast-enhanced computed tomography (CT) axial image of the ectopic parathyroid. (B) Contrast-enhanced CT sagittal image of the ectopic parathyroid (shown by an arrow).