Primary hyperparathyroidism associated with pregnancy is difficult to diagnose as symptoms are easily masked in this subgroup resulting in abortion, nephrolithiasis, pancreatitis, pre-eclampsia, hypercalcemic crisis with confusion, coma and even death in the mother. In the new-born neonatal hypocalcemia, intrauterine growth retardation, low birth weight, stillbirth, seizure, tetany, failure to thrive, bone fragility, permanent hypocalcemia can occur.

A review of six cases diagnosed in antepartum or postpartum period over a 6 year period.

Five out of six (83.3%) subjects were less than 30 years of age. Two of them had presented during pregnancy while the remaining four in postpartum period. All six presented with symptomatic bone disease including pathological fracture, one with history of ureteric stone and two had medullary nephrocalcinosis. None were associated with a familial syndrome. All six underwent parathyroidectomy for single gland adenoma localized on imaging and all were cured of disease biochemically with symptomatic improvement. Two of five deliveries at full term had intrauterine growth retardation (IUGR) and one was born pre term. Out of three tested children one had asymptomatic hypocalcemia at birth.

Health care workers in the field of obstetrics need to have awareness that primary hyperparathyroidism can present in pregnancy including the postpartum period. It is a preventable cause of maternal/foetal/new-born morbidity and mortality. Surgery is recommended in second trimester or medical management till delivery and then surgery. Outcomes are variable in this rare clinical situation.