title: PTHrP-associated hypercalcemia of pregnancy resolved after delivery: a case report.
abstract: A 35-year-old oriental woman, who was 32 weeks pregnant, was hospitalized with suspected preeclampsia. Subsequently, she developed stupor and lethargia. Biochemical assessment showed severe hypercalcemia (21 mg/dl) with undetectable parathyroid hormone (PTH) and markedly elevated PTH-related peptide (PTHrP) levels (26 pmol/l, normal values <1.1 pmol/l). The patient was treated with i.v. fluid administration, which resulted in an unsatisfactory reduction in serum calcium. Therefore, a cesarean section was performed to deliver the baby. Serum calcium levels promptly normalized after delivery with undetectable PTHrP levels. She delivered a healthy infant only presenting with transient mild jaundice and slightly prolonged QT interval with serum calcium level of 7.8-8.4 mg/dl (corrected for albumin levels). In the subsequent days, the patient developed a transient 'hungry bone' syndrome (calcium 6.7 mg/dl, phosphorous 2.1 mg/dl, and PTH 100.4 pg/ml). In conclusion, this pregnant patient presented with PTHrP-associated hypercalcemia, presumably of placental origin. Delivery resulted in prompt reduction of serum calcium levels and a transient 'hungry bone' syndrome.
authors.affiliation: Endocrinology and Diabetology Unit, Department of Medical Sciences, University of Milan, Padiglione Granelli, Fondazione Ospedale Maggiore IRCCS, Via F Sforza 35, Milan, Italy. eller.vainicher@gmail.com
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: Manuela Wally
authors.initials: MW
authors.lastname: Ossola
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000534:rehabilitation; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000378:metabolism / Q000534:rehabilitation* / Q000628:therapy; D055103:Hypodermoclysis; D007231:Infant, Newborn; D044162:Parathyroid Hormone-Related Protein / Q000009:adverse effects / Q000097:blood* / Q000378:metabolism; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000378:metabolism / Q000534:rehabilitation* / Q000628:therapy; D012075:Remission, Spontaneous
chemical_list: D044162:Parathyroid Hormone-Related Protein