Successful Conservative Management of Primary Hyperparathyroidism Diagnosed During Pregnancy

Primary hyperparathyroidism (PHP) is the third most common endocrine disorder after diabetes and thyroid disease. Women are affected twice as common as men (1). Although PHP is a very rare condition during pregnancy, it may cause feto-maternal morbidity and mortality (2). The prevalence of hyperparathyroidism in pregnancy varies from 0.15% to 1.4% (3). PHP occurs due to decreased negative feedback control and autonomous parathyroid hormone production by the parathyroid glands. The most frequent reason of PHP is a single parathyroid adenoma (85%) followed by parathyroid hyperplasia (15%-20%) (4). The treatment of PHP during pregnancy is based on severity of the disease. The optimal management in pregnancy has been debated in the literature. Conservative therapy for hypercalcemia may induce preterm delivery (5). Surgery is the most definitive treatment of PHP. Although it reduce the incidence of life-threatening maternal and fetal complications such as pre-eclampsia, miscarriage and hypercalcemic crisis, may provoke spontaneous abortion and preterm delivery (6). In this report, we aimed to present the successful conservative medical treatment of PHP diagnosed at 14 weeks of pregnancy. Case Presentation A 32-year-old pregnant woman was referred to Yuzuncu Yıl University Medical School, Obstetrics and Gynecology, Department of Perinatology, Van, Turkey at 14 weeks of gestation with severe vomiting, chronic constipation and proximal muscle weakness. There was a history of intrauterine fetal demise at third trimester in previous pregnancy. Detailed obstetric ultrasound examination was normal. According to the clinical presentation, hyperemesis gravidarum was considered as differential diagnosis. Initial laboratory findings revealed calcium level of 11.7 mg/dl (reference range 8.4-10.4 mg/dl), phosphate level of 1.8 mg/dl (reference range 2.3-4.0 mg/dl), alkaline phosphatase level of 187 (reference range 30-120 U/L), urine calcium level of 315 mg/day (reference range 100-250 mg/ day) and also parathyroid hormone (PTH) level of 89 pg/ ml (reference range 16-48 pg/ml). Serum thyrotropine, free thyroxine and free triiodothyronine levels were normally. A solid, hypoechoic nodule measured 1.8 × 0.5 × 1.1 cm in the left inferior parathyroid gland on ultrasonography was detected. Finally, PHP was diagnosed on the basis of biochemical findings. Firstly, the patient was treated with high fluid intake, low calcium diet and oral phosphate (3 g/day) by monitoring Abstract Introduction: Primary hyperparathyroidism (PHP) a rare condition that leads to severe maternal and fetal complications in pregnancy. In this report, we aimed to present the successful conservative medical treatment of PHP diagnosed during pregnancy. Case Presentation: A 32-year-old pregnant woman was referred to our clinic at 14 weeks of gestation with severe vomiting, chronic constipation and proximal muscle weakness. According to the clinical presentation, PHP was diagnosed on the basis of biochemical and ultrasonographic findings. The patient was treated with high fluid intake, low calcium diet, oral phosphate supplementation and intramuscular injection of calcitonin. At 38 weeks of gestation, healthy infant was delivered by cesarean section with mild preeclampsia. Conclusion: Treatment options of PHP, including medical and surgical therapy are debated in the literature. Early diagnosis and effective management may reduce perinatal mortality and morbidity. Although surgical treatment in the second trimester is the definitive therapy, conservative management can be preferred in mild cases of PHP in pregnancy.