A rare case of hypercalcemia-induced pancreatitis in a first trimester pregnant woman

Abstract

SummaryThe objective of the study is to report a case of acute pancreatitis secondary to hypercalcemia induced by primary hyperparathyroidism in a pregnant woman at the end of the first trimester. The case included a 32-year-old woman who was diagnosed with acute pancreatitis and severe hypercalcemia refractory to many regimens of medical therapy in the first trimester of pregnancy. She was successfully treated with parathyroidectomy in the early second trimester with complete resolution of hypercalcemia and pancreatitis. Neonatal course was unremarkable. To our best knowledge, this is a rare case when primary hyperparathyroidism and its complications are diagnosed in the first trimester of pregnancy. In conclusion, primary hyperparathyroidism is a rare life-threatening condition to the fetus and mother especially when associated with complications such as pancreatitis. Early therapeutic intervention is important to reduce the morbidity and mortality. Parathyroidectomy performed in the second trimester can be the only solution.Learning points:Learning how to make diagnosis of primary hyperparathyroidism in a woman during the first trimester of pregnancy.Understanding the complications of hypercalcemia and be aware of the high mortality and sequelae in both fetus and mother.Providing the adequate treatment in such complicated cases with coordinated care between endocrinologists and obstetricians to ensure optimal outcomes.

Successful surgical management of primary hyperparathyroidism during pregnancy: a rare case report

“…It is the third most common endocrine disease in pregnancy, affecting less than 1% of all pregnant women. Primary adenoma is the most common etiology of PHPT 8 . Acute pancreatitis is rare in pregnancy, occurring in ∼3 out of every 10 000 pregnancies 9 .…”

Hyperparathyroidism presenting as hyperemesis and acute pancreatitis in pregnancy

“…Considering that most pregnant patients with hyperparathyroidism have subtle manifestations, hyperparathyroidism-associated pancreatitis is extremely rare. [ 3 – 5 ] Pancreatitis in pregnancy is associated with maternal preeclampsia, preterm delivery, and intrauterine fetal death. [ 16 ] It is noteworthy that non-gallstone pancreatitis may result in more complications and poor outcomes.…”

“…Other than abdominal pain, nausea and vomiting are frequently reported symptoms in hyperparathyroidism-associated pancreatitis during pregnancy. [ 5 ] Although nausea and vomiting are common in early pregnancy, accompanying abdominal pain is exceptionally rare. Differential diagnoses include gastroenteritis, appendicitis, cholecystitis, peptic ulcer, intestinal obstruction, urinary tract infection, and gestational trophoblastic disease.…”

A Rare Case of Primary Hyperparathyroidism, Hyperemesis Gravidarum, and Wernicke Encephalopathy

“…Apart from the diagnostic challenges, the treatment is difficult during pregnancy because hypercalcemia and posttreatment hypocalcemia could be life-threatening to the fetus. Surgery remains the only efficient curative treatment and is recommended during the second trimester of pregnancy (10). In a retrospective analysis of hyperparathyroidism cases during pregnancy from 1930 to 1990, those treated medically had a 53% complication rate and 16% mortality, compared to those managed surgically, with complication and mortality rates of 12.5% and 2.5%, respectively (11).…”