Merina Khan¹, Nida Saleem^1,, Syed Nayer Mahmud¹, Muhammad Haneef¹

Primary hyperparathyroidism (PHPT) is characterized by the overproduction of parathyroid hormone (PTH) due to parathyroid gland hyperplasia, adenoma, or carcinoma, resulting in hypercalcemia and raised or inappropriately normal PTH levels. Primary hyperparathyroidism is rare in pregnancy, with a reported incidence of one percent. There is a direct relationship between the degree of severity of hypercalcemia and miscarriage risk, with higher rates being reported in those patients, whose serum calcium levels are greater than 11.4 mg/dL (2.85mmol/L). After taking written informed consent, we report a case of 32 years old female in the third trimester of pregnancy, who presented with recurrent symptomatic hypercalcemic episodes. A successful parathyroidectomy was performed during the third trimester of pregnancy. The patient responded dramatically with no subsequent post-operative feto-maternal complications and normal post-operative serum calcium levels. During pregnancy, the diagnosis of primary hyperparathyroidism can be difficult due to physiological changes of pregnancy. Besides this, a precise radiological diagnosis of the overactive parathyroid gland is not possible due to the risk of radiation injury to the fetus. This can lead to persistent hypercalcemia associated with numerous dreadful feto-maternal complications. In literature, there is conflicting data regarding the management of gestational hyperparathyroidism, especially during the third trimester of pregnancy. From this case, it is concluded that in a patient with recurrent symptomatic hypercalcemic episodes, even during the third trimester of pregnancy, emergency parathyroidectomy can be considered regardless of gestational age.

hyperparathyroidism, pregnancy, parathyroidectomy, hypercalcemia, miscarriages