Parathyroid Tumor Accidentally Discovered During Care of A Lady with Hyperemesis Gravidarum | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 83, Volume 96, Issue 1, July 2024, Page 2877-2882 PDF (1.02 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2024.374401 | ||||
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| 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. | ||||
| Keywords | ||||
| Parathyroid adenoma; Hyperparathyroidism; Pregnancy; Hyperemesis gravidarum; Hypercalcemia; Parathormone (PTH); Minimally invasive parathyroidectomy; Cyclin D1/PRAD1 gene; non-ionizing imaging; Refractory vomiting; Multidisciplinary team | ||||
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