Prolonged Hypocalcemia in a 2 Month-old Boy Unmasking Maternal Diagnosis of Primary Hyperparathyroidism

Abstract

Primary hyperparathyroidism in middle-aged women is most commonly diagnosed after detecting incidental hypercalcemia during a routine blood test 1 ' 2 . Occasionally, diagnosis of hyperparathyroidism in a young asymptomatic mother is made when the infant presents with hypocalcemia 3 ' 7 . Here we present an infant with severe prolonged hypocalcemia secondary to maternal asymptomatic hyperparathyroidism.A 7 week-old boy was referred to Dokuz Eylül University Children's Hospital because of recurrent hypocalcemic convulsions. He was a full term baby born to a 24 year-old mother by normal spontaneous vaginal delivery with a birth weight of 2300 g. He has had no problems during the immediate postpartum period and the first 3 weeks of life. He had been exclusively breast-fed and had adequate weight gain. At 3 weeks of age, he started having several tonic-clonic convulsions and was admitted to a local government hospital. On laboratory tests, he was found to have profound hypocalcemia and was given intravenous calcium infusions for 5 days and discharged home. At age 40 days, his tonic-clonic convulsions recurred. Laboratory tests revealed calcium of 4.7 mg/dl and phosphorus of 5.4 mg/dl. His family history was unremarkable except that his mother had passed several stones during her pregnancy. On physical examination, he was 3.7 kg (10 th percentile) in weight and 50 cm (3 rd percentile) in length; head circumference was 37 cm (2 SD). He had no

Transient neonatal hypoparathyroidism in two siblings unmasking maternal normocalcemic hyperparathyroidism

“…The majority of the patients with primary hyperparathyroidism have mild hypercalcemia, whereas about 5% of them are normocalcemic [7,11,13]. In almost all reported cases of neonatal hypoparathyroidism caused by maternal hyperparathyroidism, their mothers were hypercalcemic [1,3,8,9,12,14]. Maternal hyperparathyroidism with normocalcemia causing neonatal hypoparathyroidism has rarely been reported [5].…”

“…As a consequence, transient neonatal hypoparathyroidism can occur in an infant born to a mother with untreated hyperparathyroidism. Transient neonatal hypoparathyroidism due to maternal hypercalcemic hyperparathyroidism is not uncommon [1,3,8,9,12,14]. In contrast, maternal normocalcemic hyperparathyroidism causing neonatal hypoparathyroidism is extremely rare [5] and not easily recognized.…”

Successful Conservative Management of Primary Hyperparathyroidism Diagnosed During Pregnancy

“…Maternal complications of untreated parathyroid disorder can led to nephrolithiasis, hyperemesis or potentially life-threatening complications such as hypercalcemic crisis, preeclampsia and pancreatitis (7). Intrauterine growth retardation, low birth weight, preterm delivery, intrauterine fetal demise and postpartum neonatal tetany may occuras fetal complications (8). Early diagnosis and effective management of this condition can reduce feto-maternal mortality and morbidity.…”

Neonatal Seizure as a Manifestation of Unrecognized Maternal Hyperparathyroidism

“…Maternal hypercalcemia due to hyperparathyroidism causes increased transfer of Ca to the fetus. This leads to increased fetal Ca concentrations, suppressing fetal PTH synthesis and stimulating calcitonin secretion (1,3,4). All these mechanisms result in neonatal hypocalcemia.…”