PRIMARY HYPERPARATHYROIDISM DURING PREGNANCY AND POSTPARTUM

The prevalence of primary hyperparathyroidism (PHPT) in pregnant women is 0.15 to 1.4%. The literature reports not more than 200 cases of this condition. The authors describe their own observation. Pregnant woman I. was admitted to the Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology for the following diagnosis: 37 week pregnancy; unstable fetal position; moderate preeclampsia; asymmetric pelvis. It was confirmed that the patient had PHPT with a more than 4—8-fold increase in bone remodeling markers, which gave rise to severe hyperparathyroid osteodystrophy. There was a complete spectrum of visceral lesions characteristic of PHPT: involvements of the musculoskeletal system (severe hyperparathyroid osteodystrophy, muscular atrophy), gastrointestinal tract (chronic gastritis), and kidneys (nephrocalcinosis, nephrolithiasis complicated by urinary tract infection). Moreover, the patient had a history of manifestations of insipid syndrome (polyuria, polydypsia). The patient delivered via cesarean section in the lower segment. After delivery, a 4.5x2.0x3.0 cm ectopic parathyroid mass located near the aortic arch was thoracically removed in its capsule (this was a parathyroid adenoma showing clear cells, as evidenced by its histology). Six months after surgery for PHPT, the patient was diagnosed as having a remission. After birth the baby was intravenously given calcium and magnesium preparations, thus giving rise to normocalcemia. The infant was discharged on day 33 of his life. Thus, persistent maternal hypercalcemia retards the development of fetal parathyroid glands and, possibly, may be toxic to the fetus. In this connection, the infants born to mothers with PHPT, with its severe form in particular, need a meticulous long-term follow-up and correction to prevent hypocalcemia.

primary hyperparathyroidism, pregnancy, hypercalcemia, hypocalcemia