Concurrent parathyroidectomy and caesarean section in the third trimester

Primary hyperparathyroidism is the most common cause of hypercalcemia in the general population. It is a rare complication of pregnancy that is difficult for clinicians to recognize, yet it can have important and devastating effects for both mother and baby.

A 27-year-old primigravida at 32+3 weeks' gestation had a serum calcium level in excess of 2.75 mmol/L and evidence of HELLP syndrome. She underwent concurrent parathyroidectomy and Caesarean section. Neither the mother nor the neonate developed hypocalcemia postoperatively. The mother's parathyroid tissue was pathologically atypical, and a left hemithyroidectomy was performed at three months postpartum.

When hyperparathyroidism is diagnosed in the third trimester, concurrent parathyroidectomy and Caesarean section is a safe and reasonable option for management. This should be performed by a multidisciplinary team with careful monitoring of the calcium levels of both mother and neonate after surgery.