Parathyroid adenoma with hypertensive crisis and intracerebral hemorrhage mimicking hemolysis, elevated liver enzymes, low platelets syndrome.
BACKGROUND
Hyperparathyroidism is seldom encountered during pregnancy. Moreover, when the disease does occur, it is typically masked until late pregnancy or after delivery.


METHODS
A previously healthy multiparous woman presented with sudden-onset severe preeclampsia with hemolysis, elevated liver enzymes, low platelets syndrome at 37 weeks of gestation. Acute intracerebral hemorrhage and disseminated intravascular coagulapathy developed 24 hours after cesarean delivery and persisted after craniotomy. Hypercalcemia and hyperparathyroidism were noted, and imaging studies revealed parathyroid tumor. The patient recovered from severe preeclampsia after resection of a hemorrhagic parathyroid adenoma and was fully rehabilitated after 3 months.


CONCLUSIONS
This patient exhibited a concealed hyperparathyroidism with acute hypertensive crisis, probably attributable to hemorrhagic parathyroid adenoma. The presentation mimics acute late-onset preeclampsia and requires vigilant diagnosis followed by surgery.
From the Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, and the Graduate Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, Republic of China.
Mun-Kun
MK
Hong
Ying-Cheng
YC
Lin
Yu-Chi
YC
Wei
Tang-Yuan
TY
Chu
D000236:Adenoma / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D002585:Cesarean Section; D003399:Craniotomy; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis / Q000601:surgery; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis* / Q000601:surgery; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis* / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016105:Parathyroidectomy; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000601:surgery; D011247:Pregnancy; D012720:Severity of Illness Index
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