Surgical Treatment of Primary Hyperparathyroidism during the Second Trimester of Pregnancy—A Case Report—

Abstract

Primary hyperparathyroidism (PHPT) mainly occurs in middle-aged women, although it may occur in women of childbearing age. Treatment of PHPT is essential during pregnancy to avoid fetal complications including intrauterine growth retardation, neonatal tetany, or even fetal death. We report a case of PHPT in a woman who conceived while awaiting surgery and underwent surgery during the second trimester. A 34-year-old woman was diagnosed with hypercalcemia (serum calcium 10.7 mg/dL) during a medical checkup. She was diagnosed with PHPT based on an increased serum level of intact parathyroid hormone (i-PTH) and swelling of the left upper parathyroid gland on ultrasonography, and she was referred to our hospital for surgery. She was asymptomatic with only mild hypercalcemia and refused surgery. Therefore, we observed the patient without surgical intervention. Six years later, her serum calcium level was elevated to 11.2 mg/dL, and the parathyroid gland was enlarged. She was scheduled to undergo surgery ; however, she conceived (gestational age 6 weeks and 4 days) while awaiting surgery. We performed parathyroidectomy at a stable gestational age of 17 weeks. Histopathological examination of the resected specimen confirmed a diagnosis of parathyroid adenoma. Her serum i-PTH and calcium levels normalized postoperatively. She had a normal delivery with the birth of a healthy female neonate weighing 3,044 g, at the gestational age of 39 weeks and 6 days. The patient and neonate are doing well at the time of writing this report.