July - September 2008, Volume 4, Issue 3

Mogos V, Mogos S, Branisteanu DD, Onofriescu M, Cotea E, Tircoveanu E, Florea N, Zbranca E

Primary hyperparathyroidism during pregnancy - case report

Acta Endo (Buc) 2008, 4 (3): 337-343
doi: 10.4183/aeb.2008.337

We present the case of a 28 year old pregnant primiparous woman, suspected of primary hyperparathyroidism due to hypercalcemia discovered by routine calcium assessment at 30 weeks of gestation. Diagnosis was strongly suggested by elevated serum calcium (15.2 mg/dL, normal range: 8.4-10.3 mg/dL), low serum phosphorus (0.55 mg/dL, normal range: 2.5-5 mg/dL) and increased urinary hydroxyproline excretion (118 mg/24h, normal range: 10- 40 mg/24h), suggesting high bone turnover and confirmed by coexistence of high levels of parathyroid hormone (PTH, 145 pg/mL, normal range 10-65 pg/mL). Neck ultrasound identified a solid nodule of 33x58x20.5 mm situated behind the inferior pole of a normal thyroid left lobe, suggestive for a solid parathyroid tumour located within the left inferior parathyroid gland. Medical treatment with furosemide and hydration decreased serum calcium level but failed to normalize it. After a 3 day preparation for lung maturation with dexamethasone (16 mg per day), successful adenomectomy was performed under local anaesthesia, without major intraoperative or postoperative events. The few uterine contractions were easily managed with papaverine and progesterone. Calcium levels immediately returned to normal after surgery. Our patient delivered a healthy newborn at 40 weeks by caesarean section. A DXA BMD assay performed after one year showed significant bone loss of the mother at radius level (T score of - 2.6).

Keywords: hyperparathyroidism, hypercalcemia, pregnancy

Correspondence: Dumitru D. Branisteanu, MD, PhD, Clinic of Endocrinology, “St. Spiridon” University Hospital, Independentei Str. 1, Iasi, Romania, Tel. 0232 213 226, Fax 0232 278 224, email: dumitru_branisteanu@yahoo.com