Urgent Parathyroidectomy for Extreme Hypercalcemia in Pregnant Woman and Review of Literature

Physiological events during pregnancy, such as emesis, gastric pain and weakness can mask symptoms of primary hyperparathyroidism. In pregnant women, prolonged hypercalcemia can lead to growth retardation of the foetus and intrauterine or neonatal death. Also, it can cause pre-eclampsia, preterm delivery or pancreatitis. Imaging studies for localizing parathyroid glands in pregnancy are limited due to the radiation risk they carry with them. A 32-year-old primigravida in her 14th gestational week was admitted to the obstetric clinic for several symptoms including vomiting and epigastric pain. Laboratory tests showed an increased level of calcium (4.19 mmol/L) and parathyroid hormone (783 ng/L). Ultrasound of the neck revealed an enlarged upper right parathyroid gland. After an urgent parathyroidectomy was performed, the level of calcium and parathyroid hormone gradually normalized (2.2 mmol/L and 45 ng/L, respectively). A review of literature revealed that our case represents a very rare case of extreme hypercalcemia (> 4.0 mmol/L) in pregnancy. Surgically treated patients have lower rates of pre-eclampsia and preterm delivery compared to patients who are treated conservatively.