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Parathyroid/Bone Disorders

(20.03) A case of Primary Hyperparathyroidism presenting with Urosepsis in Pregnancy

Saturday, May 11, 2024
12:10 PM – 12:25 PM CDT
Location: ePoster Showcase, Empire Ballroom Foyer, Level 2
Introduction : Parathyroid disease is a rare occurrence during pregnancy and can present in various ways. The dynamic changes in calcium-regulating hormones throughout gestation can pose challenges in diagnosing primary hyperparathyroidism. Vigilant monitoring of serum calcium levels during pregnancy becomes imperative to enhance both maternal and fetal outcomes. Managing this condition presents additional complexities. In this instance, we will explore a case involving primary hyperparathyroidism in a pregnant woman who experienced a unique complication – urosepsis resulting from nephrolithiasis.[1], [2]

Case(s) Description :

The patient is a 30-year-old primigravida at 34 weeks of gestation with a history of nephrolithiasis diagnosed in 2020. She is an otherwise healthy female who presented to the ED on 8/14/2023 with right flank pain associated with nausea and vomiting. The initial workup showed elevated WBCs 21,000 k/cmm, elevated calcium14 mg/dl, albumin 2.6 gm/dl,PTH 33, and GFR 37 ml/min/1.73 m2. Renal ultrasound confirmed bilateral non-obstructive kidney stones with mild hydronephrosis. Endocrinology was consulted, and the patient was started on calcitonin and IV fluids, leading to an improvement in corrected calcium to 12.9mg/dl. Subsequently, the patient was discharged with nasal calcitonin.

Two days later, she was readmitted to the hospital due to persistent abdominal pain and was found to have persistent severe hypercalcemia with a corrected Ca of 15.1mg/dl. The patient received treatment with IV fluids and calcitonin, but there was no improvement. Cinacalcet 30 mg BID was initiated.Thyroid/parathyroid ultrasound revealed a 2.9 cm right inferior parathyroid gland concerning a parathyroid adenoma. A multidisciplinary decision involving ENT, endocrinology, urology, and obstetrics was made to deliver the patient at 35 weeks gestation. She was discharged with a serum calcium level of 12.2mg/dl.

Almost two weeks later, the patient underwent a right inferior parathyroidectomy, which she tolerated well. She experienced no postoperative complications, and her hypercalcemia resolved.

Discussion : The interventions for addressing primary hyperparathyroidism during pregnancy are significantly constrained, given the insufficient safety data associated with the various potential therapies. Surgical intervention is recommended during the second trimester when severe hypercalcemia is present (calcium adjusted for albumin greater than 3.0 mmol/L (12.0 mg/dl)). It is crucial to prevent hypercalcemia during pregnancy to mitigate potential complications for both the mother and the fetus. [3],[4].