Primary hyperparathyroidism in pregnancy: a two-case report and literature review

A Giant Parathyroid Tumor during Pregnancy: Adenoma versus Carcinoma

Primary hyperparathyroidism (PHP) is one of the most common endocrine diseases. However, it is rare during pregnancy. 85% cases of the PHP are due to parathyroid adenoma (PA) and less than 1% because of parathyroid carcinoma (PC). Here we report a case of giant parathyroid adenoma (GPA) in a patient with first trimester pregnancy. Her calcium and parathyroid hormone (PTH) levels were very high. The tumor measured 5 cm in greatest dimension, weighed 37 grams, and was adherent to the surrounding tissues. Grossly, the tumor was encapsulated and composed of solid and cystic components. Cut surface was reddish brown and soft. Microscopically, the tumor had a thick irregular capsule with entrapped parathyroid cells and extensive foreign body type reactions. The tumor was composed of multiple cell types with areas of pleomorphism. The mitotic index was nonetheless low. Even though the tumor was large and adherent with the surrounding strap muscles, the gross appearance and the histological morphology favored benign parathyroid adenoma. In this paper, we have discussed some important differential aspects of GPA, PA, and PC.

Clinical Presentation, Management, and Outcomes of Primary Hyperparathyroidism during Pregnancy

BACKGROUND

Primary hyperparathyroidism (pHPT) in pregnancy is a rare event, but it poses a significant risk to mothers and fetuses. The optimal treatment strategy remains controversial.

METHODS

We present a consecutive series of twelve pregnant women with pHPT.

RESULTS

Twelve women were diagnosed with pHPT during pregnancy or in the postpartum period. Four of them presented no symptoms or mild symptoms. Four patients experienced serious complications, including hypercalcaemic crisis, acute pancreatitis, and eclampsia. Another four patients were identified postpartum as the result of neonatal convulsion with hypocalcaemia. Minimally invasive parathyroidectomy (MIP) under cervical plexus block was successfully performed in 11 of them during pregnancy or postpartum. The serum levels of ionized calcium and intact parathyroid hormone (iPTH) were much higher in patients with severe complications in this cohort than those in the group of patients with no symptoms or mild symptoms and patients who were diagnosed postpartum.

CONCLUSIONS

MIP under cervical plexus block might be a safe and effective treatment for pregnant women with pHPT. Even though both conservative and surgical treatments are applicable for most mothers and fetuses with asymptomatic and mild hyperparathyroidism, serious complications may have catastrophic consequences for both.