Intrauterine growth retardation in a woman with primary hyperparathyroidism: A case report

BACKGROUND: Primary maternal hyperparathyroidism leads to increased serum calcium levels, which suppress fetal parathyroid development, leading to nypocalcemia in the neonate. CASE: In a pregnant woman, hypercalcemia was observed to be related to a parathyroid adenoma that was surgically removed at 15 weeks' gestation. Subsequently, hypocalcemia developed, requiring calcium re- placement. There was marked premature calcification of the placenta, noted to be grade 3 at 23 weeks, and this was thought to be related to the severe intrauterine growth retardation that later developed. Preterm premature rupture of membranes occurred at 33 weeks, and a growthretarded neonate with a small, calcified placenta was delivered. CONCLUSION: Pregnancies associated with hyperparathyroidism have been found to be complicated by an increased incidence of spontaneous abortion, stillbirth and neonatal tetany. There may also be an increased risk of fetal intrauterine growth retardation. Serial ultrasonography to evaluate fetal growth and antenatal testing should be considered.