Incipient primary hyperparathyroidism in a primigravida

Incipient primary hyperparathyroidism (iPHPT) is a concept that is applicable to patients who clearly have elevated serum parathyroid hormone (PTH) yet have normal calcium in the absence of other metabolic bone disorders. This is proposed to be distinctly different from and antedates asymptomatic primary hyperparathyroidism (PHPT) when there is clear biochemical evidence of hypercalcemia. A case report is presented in which iPHPT progressed to overt PHPT in a primigravida with resultant marked hypercalcemia complicated by pancreatitis in her third trimester requiring parathyroid surgery. Her postoperative course was complicated by hungry bone syndrome (HBS) and osteoporosis with a vertebral fracture in the puerperium.