Conservative Management of a Gestational Hypercalcemia Due to Primary Hyperparathyroidism with Lack of Complications

Introduction: Primary hyperparathyroidism (PHPT) is rare in pregnancy. PHPT and hypercalcemia are associated with negative maternofetal outcomes. Therefore, an early diagnosis and an adequate treatment are essential.

Results: We describe the case of a pregnant woman, complaining of nausea, vomiting and weight loss. Diagnosis of gestational PHPT (GPHPT) was done based on elevated serum calcium and parathyroid hormone levels (3.4 mmol/L and 41.6 pmol/L). Neck ultrasound documented a nodule suggestive for enlarged parathyroid, whereas abdomen ultrasound revealed renal microlithiasis. Conservative treatment was started with oral hydration and low-calcium diet. Clinical and biochemical monitoring was weekly and multidisciplinary. Despite our suggestion, the patient refused parathyroidectomy in the second trimester. Additional intravenous fluid rehydration from the 15th to the 25th week of gestation ameliorated the symptoms rapidly, and reduced progressively calcium levels from the 23th week. At week 40, the woman gave birth to a healthy girl. At month 8 postpartum, calcemia and PTH were still elevated, and accompanied by osteoporosis and nephrocalcinosis. Surgery was accepted, and a parathyroid adenoma was removed.

Conclusion: In absence of guidelines for GPHPT management, its treatment should be individualized. In our case, despite high calcium levels, a conservative treatment with strict monitoring led to positive outcome of pregnancy.

Keywords: Hypercalcemia; conservative treatment; gestational hyperparathyroidism; pregnancy; primary hyperparathyroidism.