A previously healthy 24-year-old Chinese woman was admitted to the emergency department at 37 weeks of gestation because of a sudden attack of persisting epigastric pain accompanied by nausea and bilious vomiting for 1 day. Past medical and routine obstetric examinations were unremarkable. She denied a history of familial endocrine tumours and there was no history of alcohol abuse or smoking. Her vital signs were stable, and a physical examination revealed rebound tenderness in the epigastric area. The uterine size was compatible with the period of gestation, and the cervix was dilated 1 cm and hard. The foetal heart rate was a reassuring 145 beats per minute. Initial laboratory data showed the following: white blood cell count, 28.11 × 109 /L (neutrophils 90%); serum amylase, 2861 U/L (normal values < 137 U/L); lipase, 10394 U/L (normal values < 100 U/L); creatinine 111 μmol/L (normal 44–80 μmol/L); calcium, 3.11 mmol/L (normal 2.08–2.60 mmol/L); ionized calcium, 1.77 mmol/L (normal 1.10–1.34 mmol/L); phosphorus, 0.91 mmol/L (normal 0.81–1.45 mmol/L); and magnesium, 1.22 mmol/L (normal 0.70–1.10 mmol/L). Her liver function and triglyceride were normal. An ultrasound examination revealed the patient had exudative pancreatitis with peripancreatic fluid as well as bilateral nephrolithiasis and biliary sludge without evidence of cholelithiasis. The patient was diagnosed with acute pancreatitis. Her pancreatitis was managed with fasting, intravenous fluids, analgesics, and empirical antibiotics; however, her clinical status and laboratory parameters did not improve. A caesarean delivery with spinal anaesthesia was performed the next day after the patient provided consent and discussed the procedure with a multidisciplinary team for high foetal risk. A healthy boy weighing 2620 g with an Apgar score of 9 and 9 at 1 and 5 min, respectively, was delivered. The patient’s body temperature increased to 39.0 °C 3 days after surgery. Her symptoms of pancreatitis worsened, and an abdominal enhanced computed tomography (CT) scan revealed severe necrotizing pancreatitis. The aetiology of pancreatitis showed that her initially ionized calcium levels were increasing, with a value of 1.8 mmol/L (normal 1.10–1.34 mmol/L) as well as low serum phosphorus levels. Further laboratory evaluation showed an increased PTH level (500 pg/mL; normal levels, 12–65 pg/mL) with a normal 25-hydroxyvitamin D (34 nmol/L) plasma level (normal levels, 12.3–107 nmol/L). Detailed relevant laboratory tests are shown in Table. The diagnosis of PHPT was confirmed. Technetium-99 m-sestamibi (99mTc-MIBI) scintigraphy revealed an abnormal accumulation in the right inferior parathyroid region at 15 min, and rapid 99mTc-MIBI clearance was observed in delayed 2-h images. The accurate localization of a parathyroid adenoma with a size of 2 cm was achieved with single photon emission computed tomography (SPECT)/CT. A parathyroidectomy was performed 10 days after childbirth under general anaesthesia. A single right inferior parathyroid adenoma 2.0 × 1.5 cm in size was completely removed. Histological examination revealed the chief-cell type of the parathyroid adenoma. Her calcium and PTH levels returned to normal 24 h after surgery, and hypocalcaemia occurred 3 days after surgery. However, the clinical situation of pancreatitis aggravated rapidly, and ultrasound revealed massive necrotizing tissue around the pancreas. Despite a necrosectomy with evacuation of the tissue debris and repeated percutaneous drainage, the patient developed multiple organ failure and died 72 days after childbirth. The baby boy grew uneventfully during follow-up.