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

Abstract

Introduction: Primary hyperparathyroidism (PHPT) in pregnancy is a rare condition. Because of gestational physiologic changes, it is easily under-recognized; in some cases, patients may remain symptomless while maintaining high serum calcium levels, posing a risk to the health of both mother and fetus. Case Presentation: Our patient is a pregnant woman in her 30th week of gestation admitted to the hospital with typical features of acute pancreatitis. All possible causes of acute pancreatitis were ruled out. Further investigation, including neck ultrasound, revealed a hypoechoic, well-defined, heterogeneous, and vascularized lesion measuring 1.9×1.7 cm, seen posterior to the left thyroid lobe and mostly representing a parathyroid adenoma. The patient was diagnosed to have a PHPT as the etiologic factor and underwent a successful parathyroidectomy after the failure of medical treatment. Discussion and Conclusion: Pregnancy-related parathyroid disease is uncommon. Several changes in calcium-regulating hormones occur during pregnancy, making the diagnosis of PHPT noticeably challenging. Therefore, serum calcium levels must be closely monitored during pregnancy for optimization of maternal and fetal outcomes. For the same reason, the appropriate management of gestational PHPT is mandatory, either medically or surgically.

Turning Points in Cross-Disciplinary Perspective of Primary Hyperparathyroidism and Pancreas Involvements: Hypercalcemia-Induced Pancreatitis, MEN1 Gene-Related Tumors, and Insulin Resistance

“…A particular entity is represented by acute pancreatitis with gestational primary hyperparathyroidism (representing less than 1–2% of all female cases that present a parathyroid NET) [ 31 ]. Acute severe hypercalcemia complicated or not [ 36 ] with acute pancreatitis has been reported in gestation as the first diagnosis [ 37 , 38 , 39 ], particularly in young females associated with genetic forms of hyperparathyroidism [ 40 ]. Sometimes, acute hypercalcemia triggers or mimics eclampsia/pre-eclampsia and complicates maternal/fetal outcomes, while parathyroidectomy might be necessary during pregnancy if medical therapy fails to control the abnormal serum calcium levels; alternatively, in other cases, an emergency cesarean is performed, and postpartum parathyroidectomy is later provided [ 38 ].…”

“…Sometimes, acute hypercalcemia triggers or mimics eclampsia/pre-eclampsia and complicates maternal/fetal outcomes, while parathyroidectomy might be necessary during pregnancy if medical therapy fails to control the abnormal serum calcium levels; alternatively, in other cases, an emergency cesarean is performed, and postpartum parathyroidectomy is later provided [ 38 ]. We identified five single case reports of this specific circumstance (age at presentation of 26, 30, 31—for two patients—and 40 years; two of these women developed postpartum pancreatitis [ 38 , 41 ]) [ 37 , 38 , 39 , 41 , 42 ] and one of the previously mentioned studies [ 31 ]. For example, Dias Leite et al [ 41 ] reported on a 40-year-old primigravida who was admitted as an emergency case for pre-eclampsia at week 27 of gestation.…”

“…Summarizing, in addition to the five previously mentioned cases of pregnancy primary hyperparathyroidism [ 37 , 38 , 39 , 41 , 42 ] and three reports of a parathyroid carcinoma [ 47 , 48 , 49 ], another seventeen articles introduced one patient per case study, except for two papers with two subjects (a total of nineteen individuals). Four children (aged between 9 and 14 years; an average age of 12; female-to-male ratio of three to one) and fifteen adults (aged between 31 and 81 years; mean age of 51.6 years; female-to-male ratio of two to one) were reported within the last five years in the field of hypercalcemia-derivate pancreatitis in patients with parathyroid NETs (N = 27 individuals) [ 18 , 21 , 22 , 25 , 34 , 35 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ] ( Table 4 ).…”

“…Case reports of gestational primary hyperparathyroidism complicated with acute pancreatitis during gestation or the postpartum period according to our methods of research (the table starts with the most recent publication date)[37][38][39]41,42].…”