Preeclampsia as an Inaugural Manifestation of Primary Hyperparathyroidism: A Case Report

• Published in: Revista Brasileira de ginecologia e obstetrícia 2020-12, Vol.42 (12), p.841-844
• Main Authors: Dias Leite, Sara, Ormonde, Carolina Câmara, Ormonde, Mariana Câmara, Raposo, Joana Teresa Botelho Vasconcelos, Sampaio, Joana Isabel Nunes, Melo, Bruna Carina da Silva
• Format: Article
• Language: English
• Subjects: Adenoma - complications; Adenoma - diagnosis; Adult; Case Report; Diagnosis, Differential; Female; Humans; hypercalcemia; Hyperparathyroidism, Primary - complications; Hyperparathyroidism, Primary - diagnosis; Infant, Newborn; OBSTETRICS & GYNECOLOGY; Pancreatitis - complications; Pancreatitis - diagnosis; parathyroid adenomas; Parathyroid Neoplasms - complications; Parathyroid Neoplasms - diagnosis; Pre-Eclampsia - diagnosis; preeclampsia; Pregnancy; Pregnancy Complications, Neoplastic - diagnosis; Pregnancy Trimester, Third; Prenatal Diagnosis; primary hyperparathyroidism
• ISSN: 0100-7203; 1806-9339; 1806-9339
• DOI: 10.1055/s-0040-1718447

Primary hyperparathyroidism is an endocrine disorder characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone. The diagnosis is based on a biochemical evaluation, and a neck ultrasound is the first choice during pregnancy to access the parathyroid glands. Manifestations during pregnancy are rare and can be present with life-threatening complications, so the diagnosis is challenging. The conservative treatment is limited, and there is not enough data about its safety and efficacy during pregnancy. Surgery is the only curative treatment, and a parathyroidectomy performed during the second or third trimesters is considered safe. Recently, some authors suggested an association between primary hyperparathyroidism and preeclampsia. We describe a case of preeclampsia with severe features at 27 weeks of gestational age. The severity of the preeclampsia motivated an early termination of the pregnancy by cesarean section. During the postpartum period, the patient presented life-threatening complications, such as severe hypercalcemia and acute pancreatitis. An ultrasound exam found two parathyroid nodules, suggestive of parathyroid adenomas. The patient recovered after the pharmacological correction of the calcemia levels.