Primary Hyperparathyroidism In A First-Trimester Woman With Hyperemesis Gravidarum And Pancreatitis

ABSTRACT Objective: Primary hyperparathyroidism during pregnancy is rare and is most often due to a solitary parathyroid adenoma. It is usually asymptomatic, but symptoms of hypercalcemia may be difficult to diagnosis, as they are often similar to those of pregnancy, such as fatigue and vomiting. If untreated, there is a high risk of both fetal and maternal complications. Early recognition and treatment are crucial to preventing long-term or lethal consequences. We present a case of severe primary hyperparathyroidism due to a parathyroid adenoma in a 31-year-old G3P2 female which required urgent parathyroidectomy. Methods: Case identified is described. Results: The patient was admitted at 11 weeks of gestation for refractory nausea and vomiting. Laboratory results were diagnostic for primary hyperparathyroidism and showed an elevated calcium of 12.6 mg/dL, elevated parathyroid hormone of 103 pg/mL, and low phosphorus of 1.6 mg/dL. Albumin level was normal. 25-Hydroxyvitamin D was low/normal at 25 ng/mL and 1,25-dihydroxyvitamin D level was elevated at 129 pg/mL. Amylase and lipase levels were elevated, demonstrating concomitant pancreatitis. Thyroid/neck ultrasound showed a 1.0 × 0.6 × 0.4 cm right, lower parathyroid adenoma. She was treated for pancreatitis, and a parathyroidectomy was planned for the second trimester. She returned days later with persistent nausea and vomiting and worsening hypercalcemia to a level of 14.1 mg/dL. Urgent parathyroidectomy was performed with a good outcome. Conclusion: Primary hyperparathyroidism in pregnancy is rare but must be recognized and treated to reduce maternal and fetal complications.