Gestational Primary Hyperparathyroidism Due to Ectopic Parathyroid Adenoma: Case Report and Literature Review
| Autor: | Susan E. Kirk, Alan C. Dalkin, William B. Horton, Christian A. Chisholm, Zhenqi Liu, Luke Lancaster, Meaghan M Stumpf, Joseph D Coppock, Philip W. Smith |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Parathyroidectomy
medicine.medical_specialty Parathyroid Bone and Mineral Metabolism Cinacalcet Adenoma Endocrinology Diabetes and Metabolism medicine.medical_treatment Parathyroid hormone 030209 endocrinology & metabolism Case Reports 03 medical and health sciences 0302 clinical medicine medicine primary hyperparathyroidism Pregnancy business.industry hypercalcemia medicine.disease Surgery technetium Tc 99m sestamibi medicine.anatomical_structure 030220 oncology & carcinogenesis Vomiting Parathyroid gland pregnancy medicine.symptom business hormones hormone substitutes and hormone antagonists Primary hyperparathyroidism medicine.drug |
| Zdroj: | Journal of the Endocrine Society |
| ISSN: | 2472-1972 |
| Popis: | Gestational primary hyperparathyroidism (GPHPT) is a rare condition with fewer than 200 cases reported. We present the case of a 21-year-old woman who presented at 10 weeks’ gestation with severe hypercalcemia. Laboratory investigation was consistent with primary hyperparathyroidism. Neck ultrasound did not reveal any parathyroid enlargement. Due to the persistence of severe hypercalcemia, she was treated with 4 weeks of cinacalcet therapy, which was poorly tolerated due to nausea and vomiting. At 14 weeks’ gestation, she underwent neck exploration with right lower, left upper, and partial right upper parathyroid gland excision. Intra- and postoperative parathyroid hormone (PTH) and calcium levels remained elevated. After a thorough discussion of risks/benefits, the patient requested further treatment. A parathyroid sestamibi scan (PSS) revealed an ectopic adenoma in the left mediastinum. The adenoma was removed via video-assisted thorascopic parathyroidectomy with intraoperative PTH declining to nearly undetectable levels. She ultimately delivered a physically and developmentally normal infant at 37 weeks’ gestation. Appropriate treatment of severe GPHPT may prevent the maternal and fetal complications of hypercalcemia. This case, in which cinacalcet therapy and PSS were used, adds to the body of literature regarding treatment of severe GPHPT. We present a case of gestational primary hyperparathyroidism due to ectopic parathyroid adenoma that was successfully diagnosed and treated with parathyroid sestamibi scan, cinacalcet, and surgery. |
| Databáze: | OpenAIRE |
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