Primary hyperparathyroidism: changes on biochemical and hormonal profile related to pregnancy

A woman with mild asymptomatic hypercalcemia due to primary hyperparathyroidism became pregnant and her serum calcium normalized while her hypophosphatemia worsered. The PTH was low normal, but her urinary cAMP was elevated. In the second trimester of pregnancy a parathyroid adenoma was removed. After surgery, a transient hypocalcemia that normalized ten days later, a partial recovery of hypophosphatemia, and a 40% reduction of the elevated urinary cAMP excretion were observed. Pregnancy continued uneventful and a normal newborn was delivered. This case demonstrates the diagnostic difficulties posed by primary hyperparathyroidism during pregnancy, derived from inapparent changes in serum calcium and PTH. However, phosphorus and urinary cAMP deviations are significant constituting the basis for a correct diagnosis.