Symptoms of hypercalcemia occur in 20% of patients and include fatigue, nausea, constipation, depression, renal impairment and cardiac arrhythmias. Worldwide, PHP (overproduction of PTH due to parathyroid hyperplasia, adenoma or carcinoma) is the third most common endocrine disorder, after diabetes and thyroid disease and women are twice as likely to be affected as men. Ethical approval was not required based on national laws regarding anonymized data. On October 30, at 38 weeks of gestation, the patient gave birth to a healthy female baby of adequate weight. In subsequent weekly follow-up, her serum calcium and PTH levels have been within the normal limits. (d) Positive immunohistochemistry for Ki67 (× 10), < 1%. (c) Normal parathyroid parenchyma (black arrow) at the peripheral side of the lesion (H&E, × 4). (b) Adenoma: complete disappearance of adipose tissue inside the parenchyma (H&E, × 10). (a) The microtubular and trabecular architecture of the adenoma (H&E, × 4). Her serum calcium and PTH levels normalized on May 22, PTH was 31 pg/mL and total calcium level 8.99 mg/dL. The postoperative period was uneventful in particular she did not develop hypocalcemia after surgery.

Vitamin D supplementation (25,000 IU/week) for 6 weeks (and then one time a month) was also started and continued for 6 weeks. Total calcium level at the end of the intravenous calcium infusion was 8.88 mg/dL. Intravenous glucose solution 5% (500 mL) with calcium gluconate 10% was started in the first 36 h after surgery and then was continued with oral calcium 1,000 mg two times a day. The basal level of PTH was 151 pg/mL, within 10 min after the parathyroid adenoma was removed the PTH level decreased to 12 pg/mL. The histopathology showed a benign adenoma ( Fig. On May 15 (14 weeks of gestation), the patient underwent cervical exploration with left superior parathyroidectomy. Computed tomography (CT) images of parathyroid adenoma (arrow). Neck computed tomography 4D showed a solitary adenoma of the parathyroid gland, measuring 6 × 2.9 × 11 mm ( Fig. Meanwhile obstetric evaluation showed appropriate for gestational age fetal biometry. Conservative treatment with intravenous fluid (lactated ringers 500 mL/day and normal saline 1,000 mL/day) and furosemide 20 mg/die was started, monitoring blood pressure, daily diuresis and body weight. A fine needle aspiration from the mass demonstrated scant cells, and it was reported as benign cytology. Biochemical hyperthyroidism was interpreted as consistent with pregnancy-induced rise of beta human chorionic gonadotropin. Laboratory investigations included total calcium level 11.95 mg/dL (normal range, 8.10 - 9.80), parathyroid hormone (PTH) 142 pg/mL (normal range, 11 - 67), phosphorus 1.8 mg/dL (normal range, 2.5 - 4.3), serum albumin 4.02 g/dL (normal range, 3.40 - 4.65), thyroid stimulating hormone (TSH) 0.083 mIU/L (normal range, 0.270 - 4.200) and fT4 22.80 (normal range, 9.30 - 17.00).

Thyroid ultrasound revealed an heterogeneous mass along the inferior margin of the left thyroid gland, measuring 8 mm. At admission the physical examination revealed tachycardia, and serum calcium was 12.2 mg/dL.

There was no family history of parathyroid disease, hypercalcemia, nephrolithiasis, or other endocrinopathies.

In April 2019 (April 27), a 28-year-old woman gravida 3/para 1 at 11 weeks of gestation with no previous known diseases, presented to the Obstetrics Department of the University Hospital of Brescia, Italy, with symptoms of general weakness, hyperemesis gravidarum and hypercalcemia. We report the management of a symptomatic case during pregnancy. Primary hyperparathyroidism (PHP) is the third most common endocrine disorder, often asymptomatic. Keywords: Neuroendocrine tumor Primary hyperparathyroidism Hypercalcemia Parathyroidectomy Pregnancy IntroductionĮndocrine disorders in pregnancy are challenging as regards diagnosis and treatment. The diagnostic approach to hypercalcemia in pregnancy represents a challenge for multidisciplinary teamwork. Histopathological and immunohistochemical analyses were consistent with parathyroid adenoma. Left superior parathyroidectomy resulted in immediate and permanent resolution of hypercalcemia. An ultrasound-guided fine needle aspiration from the mass confirmed the suspicious of a benign tumor. Through neck computed tomography a solitary adenoma of the parathyroid gland, measuring 6 × 2.9 × 11 mm has been documented. Corresponding to hypercalcemia, we found inappropriately elevated parathyroid hormone levels. We report the case of a 28-year-old woman who experienced general weakness, hyperemesis gravidarum and hypercalcemia at 11 weeks of gestation. Primary hyperparathyroidism (PHP) is the third most common endocrine disorder.

Hyperparathyroidism symptoms checklist