Successful surgical management of primary hyperparathyroidism during pregnancy: a rare case report

Primary hyperparathyroidism (PHPT) in pregnancy is a rare condition. Because of gestational physiologic changes, it is easily under-recognized; in some cases, patients may remain symptomless while maintaining high serum calcium levels, posing a risk to the health of both mother and fetus.

Our patient is a pregnant woman in her 30th week of gestation admitted to the hospital with typical features of acute pancreatitis. All possible causes of acute pancreatitis were ruled out. Further investigation, including neck ultrasound, revealed a hypoechoic, well-defined, heterogeneous, and vascularized lesion measuring 1.9×1.7 cm, seen posterior to the left thyroid lobe and mostly representing a parathyroid adenoma. The patient was diagnosed to have a PHPT as the etiologic factor and underwent a successful parathyroidectomy after the failure of medical treatment.

Pregnancy-related parathyroid disease is uncommon. Several changes in calcium-regulating hormones occur during pregnancy, making the diagnosis of PHPT noticeably challenging. Therefore, serum calcium levels must be closely monitored during pregnancy for optimization of maternal and fetal outcomes. For the same reason, the appropriate management of gestational PHPT is mandatory, either medically or surgically.