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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(12): 841-844
DOI: 10.1055/s-0040-1718447
Case Report

Preeclampsia as an Inaugural Manifestation of Primary Hyperparathyroidism: A Case Report

Pré-eclâmpsia como manifestação inaugural de hiperparatiroidismo primário: Um caso clínico
Sara Dias Leite 
1   Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Carolina Câmara Ormonde 
1   Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Mariana Câmara Ormonde 
1   Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Joana Teresa Botelho Vasconcelos Raposo 
1   Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Joana Isabel Nunes Sampaio 
1   Hospital Divino Espírito Santo, Ponta Delgada, Portugal
,
Bruna Carina da Silva Melo 
1   Hospital Divino Espírito Santo, Ponta Delgada, Portugal
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Abstract

Primary hyperparathyroidism is an endocrine disorder characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone. The diagnosis is based on a biochemical evaluation, and a neck ultrasound is the first choice during pregnancy to access the parathyroid glands. Manifestations during pregnancy are rare and can be present with life-threatening complications, so the diagnosis is challenging. The conservative treatment is limited, and there is not enough data about its safety and efficacy during pregnancy. Surgery is the only curative treatment, and a parathyroidectomy performed during the second or third trimesters is considered safe. Recently, some authors suggested an association between primary hyperparathyroidism and preeclampsia. We describe a case of preeclampsia with severe features at 27 weeks of gestational age. The severity of the preeclampsia motivated an early termination of the pregnancy by cesarean section. During the postpartum period, the patient presented life-threatening complications, such as severe hypercalcemia and acute pancreatitis. An ultrasound exam found two parathyroid nodules, suggestive of parathyroid adenomas. The patient recovered after the pharmacological correction of the calcemia levels.

Resumo

O hiperparatiroidismo primário é um distúrbio endócrino caraterizado pela elevação do cálcio sérico associada a níveis de paratormona elevados ou inapropriadamente normais. O diagnóstico é baseado em análises bioquímicas, e, na gravidez, o exame de imagem de primeira linha é a ecografia cervical. É uma doença rara na gravidez, e pode se apresentar com complicações ameaçadoras de vida, pelo que o seu diagnóstico é desafiante. O tratamento médico disponível é limitado, havendo poucos dados relativos à sua eficácia e segurança na gravidez. A cirurgia é o único tratamento curativo, e pode ser realizada no segundo ou terceiro trimestres. Tem sido descrita uma relação entre hiperparatiroidismo primário e pré-eclâmpsia. Apresenta-se um caso de uma grávida de 27 semanas com pré-eclâmpsia com critérios de gravidade, o que obrigou ao término da gravidez por cesariana. Verificou-se agravamento clínico no período pós-parto, com aparecimento de complicações graves, tais como hipercalcemia grave e pancreatite aguda. Ecograficamente, constataram-se duas massas paratiróideias sugestivas de adenomas da paratiroide. A doente recebeu tratamento médico, e teve melhora apenas após a correção dos níveis de cálcio sérico.

Keywords

preeclampsia - primary hyperparathyroidism - hypercalcemia - parathyroid adenomas

Palavras-chave

pré-eclâmpsia - hiperparatiroidismo primário - hipercalcemia - adenomas paratiróideos


Publication History

Received: 07 May 2020

Accepted: 12 August 2020

Article published online:
21 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Heath III H, Hodgson SF, Kennedy MA. Primary hyperparathyroidism. Incidence, morbidity, and potential economic impact in a community. N Engl J Med 1980; 302 (04) 189-193
    CrossrefPubMedSearch in Google Scholar
  • 2 Liu Y, Wang JN, Huang Y, Zhu Y-H, Liu RL, Xu CF, Li X. Acute pancreatitis and preeclampsia induced by parathyroid sdenoma in pregnancy: a case report and literature review. Int J Clin Exp Med 2016; 9 (11) 22652-22655
    PubMedSearch in Google Scholar
  • 3 Hultin H, Hellman P, Lundgren E, Olovsson M, Ekbom A, Rastad J, Montgomery SM. Association of parathyroid adenoma and pregnancy with preeclampsia. J Clin Endocrinol Metab 2009; 94 (09) 3394-3399
    CrossrefPubMedSearch in Google Scholar
  • 4 Schnatz PF, Thaxton S. Parathyroidectomy in the third trimester of pregnancy. Obstet Gynecol Surv 2005; 60 (10) 672-682
    CrossrefPubMedSearch in Google Scholar
  • 5 Ducarme G, Maire F, Chatel P, Luton D, Hammel P. Acute pancreatitis during pregnancy: a review. J Perinatol 2014; 34 (02) 87-94
    CrossrefPubMedSearch in Google Scholar
  • 6 Wisner K. Gestational hypertension and preeclampsia. MCN Am J Matern Child Nurs 2019; 44 (03) 170
    CrossrefPubMedSearch in Google Scholar
  • 7 Alharbi BA, Alqahtani MA, Hmoud M, Alhejaili EA, Badros R. Preeclampsia: a possible complication of primary hyperparathyroidism. Case Rep Obstet Gynecol 2016; 2016: 7501263
    CrossrefPubMedSearch in Google Scholar
  • 8 Perkovic V, Hewitson TD, Kelynack KJ, Martic M, Tait MG, Becker GJ. Parathyroid hormone has a prosclerotic effect on vascular smooth muscle cells. Kidney Blood Press Res 2003; 26 (01) 27-33
    CrossrefPubMedSearch in Google Scholar
  • 9 Hong MK, Lin YC, Wei YC, Chu TY. Parathyroid adenoma with hypertensive crisis and intracerebral hemorrhage mimicking hemolysis, elevated liver enzymes, low platelets syndrome. Obstet Gynecol 2011; 117 (2 Pt 2): 498-500
    CrossrefPubMedSearch in Google Scholar
  • 10 Som M, Stroup JS. Primary hyperparathyroidism and pregnancy. Proc Bayl Univ Med Cent 2011; 24 (03) 220-223
    CrossrefPubMedSearch in Google Scholar
  • 11 Ghaznavi SA, Saad NMA, Donovan LE. The biochemical profile of familial hypocalciuric hypercalcemia and primary hyperparathyroidism during pregnancy and lactation: two case reports and review of the literature. Case Rep Endocrinol 2016; 2016: 2725486
    CrossrefPubMedSearch in Google Scholar
  • 12 Dale AG, Holbrook BD, Sobel L, Rappaport VJ. Hyperparathyroidism in pregnancy leading to pancreatitis and preeclampsia with severe features. Case Rep Obstet Gynecol 2017; 2017: 6061313
    CrossrefPubMedSearch in Google Scholar
  • 13 Yilmaz BA, Altay M, Değertekin CK, Çimen AR, Iyidir ÖT, Biri A. et al. Hyperparathyroid crisis presenting with hyperemesis gravidarum. Arch Gynecol Obstet 2014; 290 (04) 811-814
    CrossrefPubMedSearch in Google Scholar
  • 14 Cooper MS. Disorders of calcium metabolism and parathyroid disease. Best Pract Res Clin Endocrinol Metab 2011; 25 (06) 975-983
    CrossrefPubMedSearch in Google Scholar
  • 15 Gonzalo García I, Robles Fradejas M, Martín Macías MLA, Ciganda AB, Beaskoetxea ZB, Pérez ER. et al. Primary hyperparathyroidism in pregnancy treated with cinacalcet: a case report. J Obstet Gynaecol 2018; 38 (01) 132-134
    CrossrefPubMedSearch in Google Scholar
  • 16 Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, Potts Jr JT. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99 (10) 3561-3569
    CrossrefPubMedSearch in Google Scholar
  • 17 Shangold MM, Dor N, Welt SI, Fleischman AR, Crenshaw Jr MC. Hyperparathyroidism and pregnancy: a review. Obstet Gynecol Surv 1982; 37 (04) 217-228
    CrossrefPubMedSearch in Google Scholar
  • 18 Parham GP, Orr Jr JW. Hyperparathyroidism secondary to parathyroid carcinoma in pregnancy. A case report. J Reprod Med 1987; 32 (02) 123-125
    PubMedSearch in Google Scholar
  • 19 Higgins RV, Hisley JC. Primary hyperparathyroidism in pregnancy. A report of two cases. J Reprod Med 1988; 33 (08) 726-730
    PubMedSearch in Google Scholar
  • 20 Trebb C, Wallace S, Ishak F, Splinter KL. Concurrent parathyroidectomy and caesarean section in the third trimester. J Obstet Gynaecol Can 2014; 36 (06) 502-505
    CrossrefPubMedSearch in Google Scholar
  • 21 Kort KC, Schiller HJ, Numann PJ. Hyperparathyroidism and pregnancy. Am J Surg 1999; 177 (01) 66-68
    CrossrefPubMedSearch in Google Scholar