Hyperemesis gravidarum as a clinical presentation of primary hyperparathyrioidism

Hyperemesis gravidarum is a rare condition with multiple causes. Diagnosis is based on clinical examination and measurement of urine ketones, serum electrolytes, and renal function. Hyperparathyroidism during pregnancy can rarely be manifested with clinical presentation of hyperemesis gravidarum with substantial maternal and fetal complications. In most cases adequate hydration, with or without forced diuresis, as well as with low calcium content diet is treatment of choice in hyperparathyroidism in pregnancy. In some cases, parathyroidectomy is treatment of choice. Case presentation Here we report a case of 31-year-old woman in the 13th gestational week who was admitted at the Obstetrician Clinic with symptoms of nausea and refractory vomiting. Laboratory tests revealed hypercalcemia with hypophosphatemia, elevated parathyroid hormone level, low vitamin D levels and hypercalciuria. After stabilization of the general condition and confirmed fetal viability, the patient was transferred to the Clinic for endocrinology, diabetes and metabolic disorders. Ultrasound of the thyroid and parathyroid glands revealed enlarged left lower parathyroid gland. During hospitalization, the patient was initially treated with abundant parenteral and enteral hydration and nutrition. The applied measures of treatment improved the electrolyte disbalance, serum electrolytes decreased, but were not normalized and the symptoms of nausea and vomiting fluctuated. Eventually, lower left parathyroidectomy was done, and the patient was cured and symptoms free. Conclusions Primary hyperparathyroidism diagnosed in pregnancy is rare, occurring in approximately 0.5 to 1.4% of pregnancies. Due to unusual clinical presentation, it may remain unrecognized, and if untreated, causes maternal and fetal complications in up to 80% of cases.  Parathyroidectomy is the only definitive treatment and is recommended for symptomatic patients, even in pregnancy.