title: Primary hyperparathyroidism mimicking hyperemesis gravidarum.
abstract: Nausea and vomiting are common complaints during pregnancy. Their severity and persistence can lead to the diagnosis of hyperemesis gravidarum, which is associated with weight loss, ketonuria, and decreased fetal birth weight. Hypercalcemia in pregnancy can confound these common gastrointestinal symptoms as well as have its own intrinsic maternal-fetal risks. A 23-year-old woman was diagnosed with primary hyperparathyroidism after multiple visits to the emergency department and the obstetrical clinic with symptoms of nausea and vomiting. Her symptoms were initially attributed to hyperemesis gravidarum and only after multiple hospital visits was her hypercalcemia discovered. Her workup led to the diagnosis of primary hyperparathyroidism caused by a solitary parathyroid adenoma. The patient was treated conservatively with intravenous fluids and eventually surgical resection of the parathyroid adenoma which led to complete resolution of her symptoms. This case demonstrates the diagnostic and therapeutic challenges associated with hyperparathyroidism in pregnancy.
authors: Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA. brian.c.benson@us.army.mil
authors: Brian C
authors: BC
authors: Benson
authors: Roy E
authors: RE
authors: Guinto
authors: Jonathan R
authors: JR
authors: Parks
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000175:diagnosis*; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000209:etiology*; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000175:diagnosis; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D055815:Young Adult
references: Lancet. 1992 Jan 18;339(8786):164-7
references: 1346019
references: Am J Surg. 1999 Jan;177(1):66-8
references: 10037311
references: J Womens Health (Larchmt). 2010 Jun;19(6):1117-21
references: 20469964
references: Lancet. 2009 Jul 11;374(9684):145-58
references: 19595349
references: Obstet Gynecol Clin North Am. 2008 Sep;35(3):401-17, viii
references: 18760227
references: Am J Med Sci. 2000 Mar;319(3):191-4
references: 10746832
references: Obstet Gynecol Surv. 1982 Apr;37(4):217-28
references: 7041021
references: Surgery. 1991 Dec;110(6):1028-33; discussion 1033-4
references: 1745971
references: Surgery. 1985 Mar;97(3):326-30
references: 3975852
references: Laryngoscope. 2008 Nov;118(11):1966-9
references: 18758377
references: Dtsch Med Wochenschr. 1995 Aug 18;120(33):1123-6
references: 7656837
references: World J Surg. 2010 Aug;34(8):1811-6
references: 20386905
references: N Engl J Med. 2011 Sep 1;365(9):843-8
references: 21879903
references: J Obstet Gynaecol. 2010 Jan;30(1):57-9
references: 20121508
references: Teratology. 1999 Aug;60(2):68-73
references: 10440778
references: J Pediatr Endocrinol Metab. 2009 Aug;22(8):741-9
references: 19845125
references: Obstet Gynecol Surv. 2005 Oct;60(10):672-82
references: 16186784
references: Hum Reprod Update. 2005 Sep-Oct;11(5):527-39
references: 16006438