Primary Hyperparathyroidism and Pregnancy (Case Study)
Primary hyperparathyroidism (PHP) has a prevalence of 0.15%; however, when taking into account the undiscovered cases that are asymptomatic, some have estimated this rate to be as high as 1.4% (1). PHP is the third most common endocrine disorder after diabetes and thyroid disease, and women are affected twice as often as men (2, 3). Most patients suffering from PHP are older than 45 years, but 25% are diagnosed in their childbearing years. Hunter and Turnbull documented the first case of hyperparathyroidism in pregnancy in 1931 (4, 5). It is theorized that the incidence of PHP in the pregnant patient is similar to that in the nonpregnant patient. PHP commonly goes unrecognized due to the physiological changes of pregnancy. Hypoalbuminemia, calcium transport across the placenta, and an increased glomerular filtration rate all contribute to the appearance of lower calcium levels in the pregnant patient. In addition, estrogen is thought to inhibit parathyroid hormone (PTH)-mediated bone resorption, causing a dose-related reduction in serum calcium in pregnancy (6). We present a case of a pregnant patient with chronic hypertension that was exacerbated throughout the course of her pregnancy with a concomitant diagnosis of PHP and its sequelae for both the mother and fetus.