A case of pregnancy with a uterine fibroid produced parathyroid hormone related protein

Abstract

 A 30-year-old primigravid, nulliparous woman was diagnosed with uterine fibroid 6 cm in diameter, and had been followed up. She became pregnant by embryo transplantation and was referred to our hospital at the 7th week of gestation. She was admitted at 13 weeks and 3 days of pregnancy due to hyperemesis, and an abnormally high blood Ca level of 16.0 mg/dL. Because of a low intact-parathyroid hormone（PTH）and high parathyroid hormone-related peptide（PTHrP）and 1, 25-dihydroxyvitamin D levels, a PTHrP-producing tumor was suspected. We did not find malignant PTHrP-producing tumor. Although the blood Ca level decreased by fluid replacement, it increased again with mild impairment of renal function. As the uterine fibroid was suspected to be a PTHrP-producing tumor, abdominal myomectomy was performed at 15 weeks and 5 days of pregnancy. Both the Ca and PTHrP levels decreased on day 1 after surgery with relief of symptoms, and she was discharged. Histopathological examination indicated uterine leiomyoma accompanied by liquefaction degeneration, and the uterine fibroid was diagnosed by immunostaining as a PTHrP-producing tumor.

 Since uterine fibroid producing PTHrP tumor is rare, the case is reported with a review of the literature.