ABSTRACT
In normal pregnancies, ionized calcium remains stable with a drop in parathyroid hormone (PTH). While hypercalcemia in pregnancy can be multifactorial, evaluation for primary hyperparathyroidism (PHPT) should be performed. PHPT is one of the most common endocrine disorders in the general population but is rarely diagnosed during pregnancy. Symptoms of gestational PHPT may be unrecognized, asymptomatic, or masked by physiologic changes in calcium homeostasis associated with pregnancy. One should consider evaluation for PHPT in pregnancy when a patient presents with severe nausea, vomiting, nephrolithiasis, peptic ulcer disease, and/or osteoporosis. Diagnosis may be made with elevated ionized calcium and PTH levels. Ultrasound of the neck is the preferred method of localization of a parathyroid adenoma during pregnancy. Conservative treatment is reasonable if the patient is asymptomatic, and parathyroidectomy in the second trimester is the only definitive treatment in pregnancy.
