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Clinical Review Lesson of the week

Rare presentation of maternal primary hyperparathyroidism

BMJ 2000; 321 doi: (Published 22 July 2000) Cite this as: BMJ 2000;321:223
  1. G C Beattie, senior house officera,
  2. N R Ravi, staff gradea,
  3. Muriel Lewis, staff grade physicianb,
  4. Hiliary Williams, specialist registrarb,
  5. A W Blair, consultantc,
  6. I W Campbell, consultantb,
  7. G G P Browning, consultanta (
  1. a Department of Surgery, Victoria Hospital, Kirkcaldy KY2 5AH,
  2. b Department of Medicine, Victoria Hospital,
  3. c Department of Paediatrics, Victoria Hospital
  1. Correspondence to: G G P Browning
  • Accepted 25 April 2000

Maternal primary hyperparathyroidism should be excluded when infants present with hypocalcaemic convulsions or tetany

Primary hyperparathyroidism is a relatively common condition, being the third most common endocrine disorder after diabetes and thyroid disease. It is most often seen in patients in their 50s and 60s,1 but it can occur in juveniles, although rarely, when the diagnosis may be delayed.2 In women of childbearing age, there is an estimated incidence of 8 per 100 000 population per year.3 Pregnant patients with primary hyperparathyroidism may be asymptomatic or have subtle symptoms such as fatigue, thirst, constipation, or transient depression. These are common complaints in the general population and pregnant patients may attribute them to pregnancy. We describe two patients, seen within one year, in whom primary hyperparathyroidism was diagnosed after convulsions in their infants. Large parathyroid adenomas were localised in both patients by using technetium sestamibi scanning, and these were surgically removed.4

Case reports

Case 1

A 33 year old multiparous woman with no major medical history delivered a girl weighing 3200 g by spontaneous vertex delivery at 39 weeks' gestation. Her first child had been born three years earlier. The baby was referred to hospital at five days of age with projectile vomiting for 12 hours. A feeding test for pyloric stenosis gave negative results. On the third day of admission the infant had a major convulsion. An infection screen gave negative results.

Routine blood tests …

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