Postpartum hyperparathyroid crisis. Case report

Hypercalcemic Crisis: A Clinical Review

“…Pancreatitis, which may be severe and necrotizing, is more common in patients with crisis (2,9,10). However, it may be argued that pancreatitis re-classifies an uncomplicated patient as one with severe disease, implying crisis (6,(11)(12)(13).…”

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

“…Conversely, rapid placental calcium transfer and uptake of calcium by the fetal skeleton during the third trimester may help protect against severe hypercalcemia in the mothers. Loss of outflow to the placenta likely explains why hypercalcemic crises have occurred after delivery of the placenta (612,662,701,795). Physical inactivity and bedrest will add an additional component of skeletal resorption.…”

“…Severe hypercalcemia, also termed a parathyroid crisis, has occurred during the postpartum interval in women with primary hyperparathyroidism who were not operated on during pregnancy, and in some women who go on to breastfeed (54,153,186,612,662,795). The sudden rise in serum calcium likely results from several factors, including abrupt loss of the placenta (a significant route of calcium loss), the initiation of low estradiol and PTHrP-induced skeletal resorption to support milk production, the effect of low estradiol to increase skeletal sensitivity to excess PTH, and physiological resorption induced by physical inactivity and bedrest during the puerperium.…”

Parathyroid Function and Disease during Pregnancy, Lactation, and Fetal/Neonatal Development

“…147,148,150,151,154 VI. THE PARATHYROIDS AND OSTEOPOROSIS This conceivably results from abrupt loss of the placenta, which represented a significant drain of calcium from the mother.…”

“…This buffering effect of the placenta will be abruptly lost after delivery, and may explain why hypercalcemic crises are more common postpartum. 150,151,154,155 Physical inactivity and bedrest can cause an additional component of bone resorption to become superimposed during late pregnancy and puerperium. The clinician should beware of the potential for primary hyperparathyroidism to rapidly worsen after delivery.…”