Hypercalcemia in pregnancy

Abstract

Hyperparathyroidism during pregnancy is not a frequent diagnosis and is generally a
diagnosis of exclusion. It may present with emetic episodes, alteration of the mental
sphere and of the state of consciousness, and abdominal pain. This causes difficulties
in its initial diagnosis and delay in starting treatment that leads to complications
such as gestational loss. The case presented is of a 30-year-old pregnant woman of
8.5 weeks, with no known history of chronic hypertension, who was admitted with
neurological symptoms associated with persistent hyperemesis, polyarthralgia and
hypertensive crisis. Autoimmune disease was ruled out. She had normal vitamin
levels, with evidence of altered renal function, hypercalcemia and calciuria, renal
ultrasound with nephrocalcinosis and thyroid ultrasound with apparent parathyroid
mass. She showed a torpid neurological evolution. The diagnosis was primary
hyperparathyroidism with high obstetric risk, requiring termination of pregnancy
and resection of the parathyroid lesion. Symptomatology, renal function and calcium
levels improved. Primary hyperparathyroidism is not a frequent etiology in pregnant
women, being more a diagnosis of exclusion, with a wide spectrum in its clinical
presentation.