# Hypercalcemia in Pregnancy Caused by a Uterine Myoma

## TL;DR

A uterine myoma producing PTH-related peptide caused severe hypercalcemia in a pregnant woman, requiring urgent treatment with hydration and calcitonin.

## Contribution

The case highlights the rare but critical occurrence of PTH-related peptide-induced hypercalcemia during pregnancy.

## Key findings

- The patient had a serum calcium level of 17.9 mg/dL due to a PTH-related peptide-producing uterine myoma.
- Hydration and calcitonin were effective in treating the hypercalcemia during pregnancy.
- Bisphosphonates are contraindicated in pregnancy, emphasizing the need for alternative treatments.

## Abstract

We present a case of a PTH-related peptide (PTH-rp) producing uterine myoma, leading to hypercalcemia in pregnancy. Our patient presented with dehydration, hypotension, delirium, and malnutrition. Due to a serum calcium level of 17.9 mg/dL (4.48 mmol/L) (reference range 8.8-11.2 mg/dL; 2.20-2.80 mmol/L), prompt treatment with hydration and calcitonin was initiated. The patient went into labor before we could consider other treatment options. Although uncommon in pregnancy, it is of great importance to identify hypercalcemia since it is related to a high risk of maternal and neonatal morbidity and mortality. Because bisphosphonates are contraindicated in pregnancy, hydration and calcitonin are the cornerstones of treatment for PTH-rp-induced hypercalcemia.