Journal of Innovative Clinical Trials and Case Reports

Abstract

Introduction: Primary hyperparathyroidism during pregnancy is a rare condition (incidence: 0.15%) yet potentially serious, associated with significant maternal, obstetrical, and neonatal complications. Optimal management remains controversial, with debate between conservative treatment and surgical intervention.

Case Report: We report the case of a 22-year-old patient, G2P1, with a 3-cm parathyroid adenoma diagnosed six months before pregnancy following the investigation of dysphagia. The patient had elevated PTH levels with normal serum calcium. Close clinical and biological monitoring throughout pregnancy was unremarkable. The patient was admitted at 39 weeks and 6 days of gestation for premature rupture of membranes. Vaginal delivery was uncomplicated, with the birth of a 3,850 g newborn with Apgar scores of 10/10.

Discussion: This case illustrates the potential for a favorable outcome with conservative management in asymptomatic forms of primary hyperparathyroidism during pregnancy. Comparative analysis of the literature reveals that second-trimester parathyroidectomy remains the gold-standard treatment in cases of symptomatic hypercalcemia (calcium > 110 mg/L), while a conservative approach can be considered in paucisymptomatic forms with normal or moderately elevated calcium levels. Neonatal follow-up is crucial, as neonatal hypocalcemia occurs in 50% of cases, typically between the 5th and 14th postpartum day.

Conclusion: Early diagnosis and multidisciplinary surveillance are essential to optimize maternal and neonatal prognosis. The therapeutic choice should be individualized according to the severity of hypercalcemia and gestational age.