Parathyroid Tumor Accidentally Discovered During Care of A Lady with Hyperemesis Gravidarum

Abstract

Background: Parathyroid adenoma, a rare but significant endocrine disorder, is often overshadowed by more common conditions during  pregnancy, such as hyperemesis gravidarum. Hyperparathyroidism, which primarily results from a solitary parathyroid adenoma  in 80-85% of cases, is characterized by the excessive production of parathormone (PTH), leading to hypercalcemia. This disorder is  predominantly seen in women aged 50-70 years, and its occurrence in younger populations, particularly during pregnancy is uncommon.

Subject and methods: A 37-year-old multiparous woman, at 13 weeks of gestation, experienced severe vomiting resistant to standard  treatment for hyperemesis gravidarum. Hyperemesis gravidarum, a condition marked by severe and persistent nausea and vomiting  during pregnancy, typically manifests in the first trimester and can lead to significant maternal and fetal morbidity. When hyperemesis  gravidarum is resistant to standard treatment protocols, it necessitates a thorough investigation for atypical etiologies. One such rare but  critical differential diagnosis is hyperparathyroidism due to parathyroid adenoma, which can present with elevated calcium levels  and refractory vomiting. Diagnosing parathyroid adenoma during pregnancy poses unique challenges. Routine diagnostic procedures for  hyperparathyroidism include ultrasound and nuclear imaging techniques such as single-radioisotope scintigraphy with 99 mTc and  SPECT imaging, which boast high sensitivity for parathyroid localization. However, the use of ionizing radiation is contraindicated in pregnancy, steering the preference towards non-ionizing imaging modalities like MRI, despite its comparatively lower sensitivity range of  40-85%.

Management: Management of hyperparathyroidism during pregnancy requires a multidisciplinary team (MDT) approach to  ensure both maternal and fetal safety. Minimally invasive parathyroidectomy has emerged as the gold standard treatment, especially  given the predominance of single adenomas, and has largely supplanted traditional bilateral four-gland exploration.

Conclusion: Early  diagnosis, a multidisciplinary approach, and timely surgical intervention are crucial for optimal outcomes. This case underscored the  importance of considering rare endocrine causes in persistent hyperemesis gravidarum and demonstrated the success of minimally  invasive surgery in managing this condition effectively.