Two Cases of Primary Hyperparathyroidism During Pregnancy and Post-Partum

Abstract

Primary hyperparathyroidism (PHPT) is rare in pregnancy and poses diagnostic challenges due to overlapping symptoms. This case series highlights diagnostic and management challenges in pregnant patients. Case 1: A 42-year-old woman at 33 weeks' gestation exhibited severe nausea and fatigue. Laboratory testing revealed elevated calcium 13.2 mg/dL (3.29 mmol/L) (reference range, 8.4-10.3 mg/dL [2.2-2.6 mmol/L]) and parathyroid hormone (PTH) 215 pg/mL (23.89 nmol/L) (reference range, 11-68 pg/mL [SI: 1.6-7.2 pmol/L]). Neck ultrasound identified bilateral parathyroid adenomas and abdominal ultrasound showed polyhydramnios. Parathyroidectomy resulted in calcium drop to 9.5 mg/dL (2.27 mmol/L) and PTH to 12 pg/mL (1.33 pmol/L). She delivered a healthy infant. Case 2: A 39-year-old woman at 39 weeks' underwent a cesarean delivery due to transverse fetal lie. She had high prepartum calcium of 14.2 mg/dL (3.55 mmol/L) and PTH 319 pg/mL (33.81 pmol/L). Post pregnancy, bilateral neck exploration and left inferior parathyroid excision decreased calcium to 8.9 mg/dL (2.22 mmol/L) and PTH to 16.5 pg/mL (1.75 pmol/L). These cases highlight that symptom severity-not just calcium level-should guide parathyroidectomy. Third-trimester surgery can be safely performed when symptomatic; asymptomatic patients may be managed expectantly. Early recognition and individualized management optimize maternal and fetal outcomes.

Keywords: hypercalcemia in pregnancy; parathyroidectomy during pregnancy; primary hyperparathyroidism.

Figure 1.

(Case 1): thyroid ultrasound demonstrating bilateral parathyroid adenomas. A, The transverse image of left side of neck showing a well-defined, hypoechoic nodule posterior to the left thyroid lobe, measuring 1.7 cm, suggestive of parathyroid adenoma. B, The transverse image of right side of neck showing a similar hypoechoic nodule posterior to the right thyroid lobe, also measuring approximately 1.7 cm, consistent with parathyroid adenoma.

Figure 2.

(Case 2): thyroid ultrasound demonstrating bilateral thyroid nodules. A, Transverse image of left thyroid lobe showing a solid, isoechoic nodule in the left superior thyroid pole, measuring 1.2 cm. B, Transverse image of left thyroid lobe showing a solid, hypoechoic nodule in the left inferior thyroid pole, measuring 1.4 cm.

Figure 3.

(Case 1): histopathology of parathyroid adenoma. High-power view of a hypercellular parathyroid gland. *The stromal adipocytes (highlighted in arrow) are markedly reduced and, in some foci, completely absent.

Figure 4.

(Case 2): gross specimen of parathyroid adenoma. Gross examination reveals a well circumscribed, reddish-brown soft mass measuring 1.8 cm in length, consistent with a parathyroid adenoma.