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Surgical treatment of primary hyperparathyroidism during the third trimester
1Departments of Obstetrics and Gynecology and Internal Medicine, The University of Connecticut School of Medicine, Farmington, and Hartford Hospital, Hartford, Connecticut, USA. pschnat@harthosp.org
Background:
Primary hyperparathyroidism is a rare diagnosis in the third trimester of pregnancy. A 58% fetal complication rate, including perinatal death and preterm labor, following late gestation parathyroidectomy has been reported. These statistics, however, are based on small sample sizes and were reported when our current technology was unavailable.
Case:
A 30-year-old woman presented in the early third trimester with primary hyperparathyroidism. Despite conservative management, her ionized calcium level increased to 1.88 mmol/L (normal 1.17-1.33 mmol/L). At 3447 weeks, she had an uncomplicated parathyroidectomy. At 3837 weeks she delivered a 3182-g female infant. Neither the mother nor baby had complications.
Conclusion:
This supports the contention that pregnant women with hyperparathyroidism not controlled by conservative measures can be treated successfully with parathyroidectomy, regardless of gestational age.