CASE REPORTS OF PRIMARY HYPERPARATHYROIDISM IN PREGNANCY

Abstract

INTRODUCTION/BACKGROUND
Primary hyperparathyroidism (PHPT) during pregnancy is uncommon. Early detection is crucial due to its association with increased maternal and foetal morbidity and mortality. Diagnosis is challenging and requires high clinical suspicion due to nonspecific presentation and the overlap of symptoms of hypercalcemia with those of pregnancy. Furthermore, serum calcium is not routinely tested antenatally. The interpretation of serum calcium and parathyroid hormone levels differs significantly from that in nonpregnant patients due to physiological changes during pregnancy. Preoperative localisation and treatment options are limited due to uncertainties regarding safety in pregnancy. We present 2 cases of PHPT who underwent parathyroidectomy during pregnancy. We retrospectively reviewed PHPT cases in Hospital Pulau Pinang from 2020 to 2023. Patients were identified from the laboratory database and clinical details were obtained from their medical records.

CASE
Two patients, with mean age of 34 years, were diagnosed with PHPT pre-pregnancy. The first patient was diagnosed with PHPT during routine blood testing for chronic myeloid leukaemia follow-up. She had left inferior parathyroidectomy and yet her post-operative serum calcium was persistently elevated. Repeated Tc99m sestamibi showed 2 foci of increased tracer uptake. During scheduled clinic visit, she informed us of her pregnancy. Exploratory parathyroidectomy was scheduled. The second patient was diagnosed with PHPT when she was admitted for acute pancreatitis. She was found to be pregnant when she was re-admitted for another episode of acute pancreatitis. Emergency parathyroidectomy was arranged due to persistent hypercalcemia despite on rehydration. Postoperatively, both were discharged with normalization of serum calcium level. However, the first patient had complete miscarriage in the second trimester; the second patient developed preeclampsia and delivered a preterm baby at 34 weeks.

CONCLUSION
Early parathyroidectomy in PHPT patients diagnosed at child-bearing age helps to prevent complications during pregnancy.