Case Report: Laser thermal ablation for severe primary hyperparathyroidism in a pregnant patient with MEN1 syndrome

Primary hyperparathyroidism (PHPT) during pregnancy is a rare clinical entity associated with substantial maternal and fetal morbidity, particularly when complicated by severe hypercalcemia. We present the case of a 44-year-old multigravida at 27 + 5 weeks' gestation who presented with symptomatic, severe hypercalcemia (3.12 mmol/L), and acute kidney injury. Diagnostic evaluation confirmed bilateral parathyroid lesions. Due to high surgical risk and patient refusal of traditional parathyroidectomy, ultrasound-guided laser thermal ablation (LTA) of the dominant right inferior adenoma was performed. The procedure induced a rapid reduction in parathyroid hormone (PTH) concentrations and normalization of serum calcium levels, accompanied by a marked recovery of renal function. Subsequent genetic testing identified a pathogenic MEN1 mutation, confirming multiple endocrine neoplasia type 1. At 39 weeks of gestation, the patient delivered a healthy infant via elective cesarean section, with no evidence of neonatal hypocalcemia. This case demonstrates that LTA may serve as a safe, effective, and minimally invasive alternative for managing severe PHPT in pregnancy when conventional surgery is contraindicated or declined. To our knowledge, this represents the first reported application of LTA in this specific clinical scenario.