Two Cases of Primary Hyperparathyroidism During Pregnancy and Post-Partum

TL;DR

This paper presents two cases of rare parathyroid disorders during pregnancy, showing how surgery can safely manage severe symptoms and improve outcomes for mothers and babies.

Contribution

The study emphasizes symptom severity as a key factor for surgery in pregnant patients with parathyroid issues, challenging traditional calcium-level-based decisions.

Findings

Parathyroidectomy in the third trimester safely reduced maternal calcium and PTH levels and resulted in healthy deliveries.

Symptomatic patients should be considered for surgery even with borderline calcium levels, while asymptomatic cases can be managed expectantly.

Early diagnosis and individualized treatment plans are crucial for optimizing outcomes in pregnant patients with PHPT.

Abstract

Primary hyperparathyroidism (PHPT) is rare in pregnancy and poses diagnostic challenges due to overlapping symptoms. This case series highlights diagnostic and management challenges in pregnant patients. Case 1: A 42-year-old woman at 33 weeks’ gestation exhibited severe nausea and fatigue. Laboratory testing revealed elevated calcium 13.2 mg/dL (3.29 mmol/L) (reference range, 8.4-10.3 mg/dL [2.2-2.6 mmol/L]) and parathyroid hormone (PTH) 215 pg/mL (23.89 nmol/L) (reference range, 11-68 pg/mL [SI: 1.6-7.2 pmol/L]). Neck ultrasound identified bilateral parathyroid adenomas and abdominal ultrasound showed polyhydramnios. Parathyroidectomy resulted in calcium drop to 9.5 mg/dL (2.27 mmol/L) and PTH to 12 pg/mL (1.33 pmol/L). She delivered a healthy infant. Case 2: A 39-year-old woman at 39 weeks’ underwent a cesarean delivery due to transverse fetal lie. She had high prepartum calcium of 14.2 mg/dL (3.55 mmol/L) and PTH 319 pg/mL (33.81 pmol/L). Post pregnancy, bilateral neck exploration and left inferior parathyroid excision decreased calcium to 8.9 mg/dL (2.22 mmol/L) and PTH to 16.5 pg/mL (1.75 pmol/L). These cases highlight that symptom severity—not just calcium level—should guide parathyroidectomy. Third-trimester surgery can be safely performed when symptomatic; asymptomatic patients may be managed expectantly. Early recognition and individualized management optimize maternal and fetal outcomes.

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