Humoral hypercalcemia of pregnancy treated with bisphosphonates

被引:8
作者
Koren, Ronit [1 ,2 ,3 ]
Neeman, Ortal [2 ,3 ]
Koren, Shlomit [3 ,4 ,5 ]
Benbassat, Carlos A. [3 ,4 ]
机构
[1] Assaf Harofeh Med Ctr, Dept Internal Med A, Zerifin, Israel
[2] Assaf Harofeh Med Ctr, Div Maternal Fetal Med, Dept Obstet & Gynecol, Zerifin, Israel
[3] Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
[4] Assaf Harofeh Med Ctr, Endocrine Inst, Zerifin, Israel
[5] Assaf Harofeh Med Ctr, Diabet Unit, Zerifin, Israel
来源
ARCHIVES OF ENDOCRINOLOGY METABOLISM | 2018年 / 62卷 / 01期
关键词
HORMONE-RELATED PROTEIN; MILK-ALKALI SYNDROME; PRIMARY HYPERPARATHYROIDISM; PARATHYROID-HORMONE; BONE METABOLISM; CASE SERIES; LACTATION; SECONDARY; CALCIUM; OSTEOPOROSIS;
D O I
10.20945/2359-3997000000016
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Hypercalcemia can be hazardous during pregnancy, most cases being due to primary hyperparathyroidism. We report a case of hypercalcemia with suppressed PTH levels necessitating treatment with bisphosphonates during pregnancy. A 38-year-old woman at the 26th week gestation was admitted because of symptomatic hypercalcemia. She did not take any medication that could influence her calcium levels. Physical examination was unremarkable. Laboratory tests on admission were: calcium 12.7 mg/dL (8.5-10.5 mg/dL), phosphorus 1.8 mg/dL (2.5-4.5 mg/dL) and PTH on 3 consecutive tests 1.2, 1.3 and 1.2 pg/mL (15-65 pg/mL). Her 24h urine calcium was 900 mg, 25-OH-D 40 ng/mL (30-58 ng/mL) and 1,25-OH-D 99 pg/mL (80-146 for women in the third trimester). Abdominal ultrasound revealed multiple hypervascular liver lesions consistent with hemangiomas by MRI. Breast and neck ultrasound were normal, and chest CT revealed few non-significant 0.3-0.7 cm pulmonary nodules with no change after an interval of 3 months. She was treated with isotonic saline, loop diuretics and calcitonin. Despite this treatment, calcium levels remained high (14.1 mg/dL), and pamidronate was initiated. On 35th week gestation, she underwent a cesarean section complicated by hypocalcemia of the newborn. Eight weeks after delivery, her calcium levels are 9.4 mg/dL and PTH 18 mg/dL. According to the extensive workup and the post-partum normalization of PTH and calcium levels, we conclude that excessive secretion of placental PTHrP was the cause of hypercalcemia in this patient. No significant adverse effect of bisphosphonate on the mother or baby were seen at the short term follow up.
引用
收藏
页码:125 / 128
页数:4
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