Idiopathic Hypoparathyroidism and Severe Hypocalcemia in Pregnancy

Abstract

The objective of this study is to report a case of severe hypocalcemia secondary to hypoparathyroidism in a pregnant woman. We report a case of a 45-year-old woman who presented for tonico-clonic seizure in the third trimester of gestation. She was diagnosed with idiopathic hypoparathyroidism for the first time during pregnancy. She was successfully treated with calcium and calcitriol in the rest of her pregnancy with resolution of symptoms but her infant was born with hypercalcemia and secondary hyperparathyroidism due to the late maternal presentation. To the best of our knowledge, hypoparathyroidism is a disorder rarely observed during pregnancy, resulting in most cases from surgical thyroidectomy.

Hypoparathyroidism and Pseudohypoparathyroidism in Pregnancy: An Italian Retrospective Observational Study

“…Until now, only limited case reports or case series of pregnant/lactating hypoparathyroid women have been published (1,20,22,24,(29)(30)(31)(32)(33). Among these, the largest case series described 12 cases with HypoPT (20,33), while for women with pseudo-hypoPT, only case reports are available (34)(35)(36)38).…”

“…Among these miscarriages, 2 women stopped calcium therapy without consulting their physician. Only 3 women with HypoPT (12%, 3/25), average age 32 years (range: [29][30][31][32][33][34][35], underwent assisted reproduction treatment; in 1/3, the reason was infertility of the partner. Most of the women with HypoPT had a term birth (80%, 20/25); only 2 women (8%) had a postterm birth; 3 (12%) women had a preterm birth.…”

Successful pregnancy outcome in a case of idiopathic primary hypoparathyroidism with seizure disorder: a case report

“…The prevalence of hypoparathyroidism ranges from 0.5 to 6.6% worldwide, however there is no available data in pregnant women. 2 Hypoparathyroidism can be of primary or secondary type. Primary hypoparathyroidism (PHP) results from absence or deficient production of parathyroid hormone (PTH).…”

“…Causes most commonly includes iatrogenic events like surgical injury/inadvertent removal of parathyroid gland during thyroid/parathyroid surgery, followed by noniatrogenic causes like autoimmune destruction of the parathyroid gland as seen in autoimmune polyglandular syndrome type 1, genetic abnormalities (Di Georges syndrome) or other acquired causes like radiotherapy or infiltrative diseases (Wilson's disease ,granulomas or metastatic disease). 2,3 However, specific causes cannot be identified promptly in few cases(Idiopathic). In Secondary hypoparathyroidism, parathyroid gland dysfunction is the consequence of a primary problem elsewhere, leading to hypercalcinemia finally resulting in low PTH levels.…”

“…4 PHP in pregnancy has been seen to be associated with maternal morbidity and fetal loss. 2,5,6 In pregnancy with hypoparathyroidism, physiological rise in calcitriol level during pregnancy enhances the intestinal calcium absorption which in turn further reduce the PTH level leading to hypercalciuria. This sometimes increases the risk of renal stones during pregnancy.…”