Refardt Julie, Farina Patricia, Hoesli Irene, Meier Christian
a Division of Endocrinology, Diabetes and Metabolism , University Hospital Basel , Switzerland.
b Department of Obstetrics and Gynecology , University Hospital Basel , Switzerland.
Gynecol Endocrinol. 2018 Oct;34(10):833-836. doi: 10.1080/09513590.2018.1462314. Epub 2018 Apr 16.
Hypercalcemia due to primary hyperparathyroidism during pregnancy is a rare condition and associated with increased morbidity and mortality for the mother and the unborn child. Whereas parathyroidectomy is favored during the second trimester, no clear recommendations exist for its management during the third trimenon. We here report the case of a 26-year-old woman in the 29th week of her first pregnancy, who was admitted to our clinic with hypertension, intra-uterine growth retardation and polyhydramnios. Severe hypercalcemia due to primary hyperparathyroidism was diagnosed (total calcium 3.34 mmol/l; PTH 216 pg/ml), but no enlarged parathyroid gland could be localized by ultrasound. Treatment with calcitonin and cinacalcet could not control hypercalcemia. Therefore explorative surgery was performed and a single parathyroid adenoma was resected, resulting in normalization of serum calcium levels. The surgical procedure was tolerated well by the mother and fetus. Hypercalcemia-induced hypertension and polyhydramnios ameliorated before C-section was performed two weeks later and unrelated to the intervention. This case report underlines the importance of early diagnosis and treatment of primary hyperparathyroidism during pregnancy. If diagnosed in the third trimenon, an interdisciplinary approach is crucial. If medical treatment fails to sufficiently control hypercalcemia, surgical parathyroid exploration should be considered even in cases of unsuccessful localization of adenomatous parathyroid glands.
妊娠期间原发性甲状旁腺功能亢进所致的高钙血症是一种罕见病症，与母亲和未出生胎儿的发病率及死亡率增加相关。虽然在孕中期进行甲状旁腺切除术较为适宜，但对于孕晚期的治疗尚无明确建议。我们在此报告一例26岁初产妇，孕29周，因高血压、胎儿宫内生长受限和羊水过多入住我院。诊断为原发性甲状旁腺功能亢进所致的严重高钙血症（总钙3.34 mmol/l；甲状旁腺激素216 pg/ml），但超声未发现甲状旁腺增大。降钙素和西那卡塞治疗无法控制高钙血症。因此进行了探查性手术，切除了一枚甲状旁腺腺瘤，血清钙水平恢复正常。母亲和胎儿对手术耐受良好。高钙血症所致的高血压和羊水过多在两周后剖宫产术前有所改善，且与干预无关。本病例报告强调了妊娠期间原发性甲状旁腺功能亢进早期诊断和治疗的重要性。如果在孕晚期确诊，多学科方法至关重要。如果药物治疗未能充分控制高钙血症，即使腺瘤性甲状旁腺定位不成功，也应考虑进行甲状旁腺探查手术。
