Category: Calcium/Bone Disorders

Monitor: 15

15 - PARATHYROIDECTOMY IN FIRST TRIMESTER OF PREGNANCY

Friday, Apr 26
12:30 PM – 1:00 PM

Objective :

Primary hyperparathyroidism is rarely diagnosed in pregnancy. Complications arising from hyperparathyroidism and subsequent hypercalcemia carry high morbidity and mortality for both fetus and mother, including neonatal hypocalcemia.


Methods : n/a


Results : n/a


Discussion :

We report the case of a 31 year-old female G1P0 who presented at 6 weeks gestation with 2 weeks of nausea, vomiting, polyuria, constipation, and generalized weakness and found to have a serum calcium of 14.1 mg/dL (8.5-10.1 mg/dL), albumin 3.2 g/dL (3.4-5.0 g/dL), phosphorus 1.6 mg/dL (2.5-4.9 mg/dL), PTH of 850.5 pg/mL (18.5-88 pg/mL), 25-OH vitamin D 200 pg/mL (20.0-82.0 pg/mL), and serum C-telopeptide level 4,416 pg/mL (Premenopausal women 34-635 pg/mL). An ultrasound of the neck showed a 5.2 x 3.1 cm right inferior parathyroid adenoma. She was started on calcitonin and aggressive intravenous fluid therapy but developed tachyphylaxis to calcitonin. She remained significantly hypercalcemic with corrected calcium levels ranging between 11.1 – 13.3 mg/dL. Treatment with a bisphosphonate and cinacalcet were considered but not administered because of the lack of safety data regarding potential fetal complications when used during pregnancy, particularly in the first trimester. 


In a multidisciplinary conference including endocrinology, maternal-fetal medicine, and otolaryngology, it was decided that because of the extreme degree of hypercalcemia that surgery could not be delayed until the second trimester. At 7w3d gestational age the patient underwent parathyroidectomy with removal of a 5 x 4 x 3 cm right inferior parathyroid gland. The intraoperative PTH decreased from 807.1 to 35.5 pg/mL. The pathology showed a parathyroid adenoma with nuclear atypia and one lymph node negative for tumor. Genetic testing for Hyperpararthyroidism-jaw tumor syndrome was also performed and patient did not have a mutation of CD72 gene.


Conclusion :

Following surgery the patient’s calcium levels have been in the reference range and there has been normal fetal development and growth.  This case illustrates importance of a multi-disciplinarian approach to managing parathyroid disease in pregnancy.

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Sonia G. Sharma

Fellow
Louisiana State University Health Sciences Center Shreveport
Shreveport, Louisiana

Fellow at Louisiana State University Health Sciences Center Shreveport in Department of Medicine, Section of Endocrinology and Metabolism

Steven N. Levine

Professor of Medicine
Louisiana State University Health Sciences Center Shreveport
Shreveport, Louisiana

Professor of Medicine, Department of Medicine, Section of Endocrinology and Metabolism

Rajini K. Yatavelli

Assistant Professor-Clinical Medicine
Louisiana State University Health Sciences Center Shreveport

Assistant Professor of Clinical Medicine in Section of Endocrinology and Metabolism

Manish A. Shaha

House Officer
Louisiana State University Health Sciences Center Shreveport

House Officer in Department of Otolaryngology

Cherie-Ann O. Nathan

Department Chairman/Professor of Otolaryngology
Louisiana State University Health Sciences Center Shreveport
Shreveport, Louisiana

Department Chairman/Professor of Otolaryngology