Primary Hyperparathyroidism in Pregnancy: A Case Report

懷孕中原發性副甲狀腺亢進屬於極為罕見之狀況同時診斷方面亦具相當之困難。性若無適當之處置對母親及胎兒均易造成嚴重之併發症。本篇我們報導一併發原發性副甲狀腺亢進之孕婦。於妊娠34週時因下肢疼痛，高血鈣與高副甲狀腺素而入院。放射診斷發現頭骨之骨質硬化性小結節，手指骨亦發現骨質吸收融解之病變，及恥骨之骨折.副甲狀腺腺瘤所引起之副甲狀腺亢進被高度懷疑。生理食鹽水灌注與硫酸錢使用卻無法達到有效之高血鈣控制，於懷孕35週時，此孕婦產下一嬰兒並於產後發生新生兒位血鈣現象，產後母親接受核子醫學檢查，發現右下副甲狀腺之位置有高濃度之核子訊。號隨後此孕婦接受副甲狀腺切除，病理報告證實為副甲狀腺腺瘤。本病例中以藥物控制副甲狀腺亢進之孕婦發現療效不良之狀況，暗示著我們，即使處於懷孕末期，實施副甲狀腺切除可能仍屬必要。而新生兒亦應注意防止低血鈣之併發症。而對於高血鈣，腎結石，或不明原因骨折之孕婦，原發性副甲狀腺亢進仍須仔細考慮其可能性。

關鍵字

原發性副甲狀腺亢進；副甲狀腺瘤；新生兒低血鈣；懷孕

並列摘要

Primary hyperparathyroidism during pregnancy is a rare disorder. When managed inappropriately, it is associated with significant maternal and fetal morbidity. We present a pregnant woman who presented with hypercalcemia, hyperparathyroidism, and lower leg pain at 34 weeks' gestation. Radiography revealed multiple osteosclerotic nodules of the skull, subperiosteal resorption over the metacarpal bone, and pubic bone fracture. Primary hyperparathyroidism due to parathyroid adenoma was impressed. Normal saline and magnesium sulfate was administered, but was ineffective in controlling the hypercalcemia. At 35 weeks gestation, she delivered a health baby. However, the infant developed transient hypocalcemia 12 hours postpratum. After calcium supplement, the infant recovered well and was discharged 2 weeks pospartum. Postpartum parathyroid scan of the mother revealed radiotracer accumulation at the inferior right parathyroid level. She underwent parathyroidectomy at 3 weeks post delivery, which confirmed the presence of parathyroid adenoma. In conclusion, in cases of primary hyperparathyroidism during pregnancy, poor response to medical therapy may necessitate parathyroidectomy, even in third trimester. Neonatal hypocalcemia should be close monitored and prevented. The possibility of primary hyperparathyroidism should be considered in pregnant patients presenting with hypercalcemia, nephrolithiasis, or idiopathic bone fracture.

並列關鍵字

primary hyperparathyroidism ； parathyroid adenoma ； neonatal hypocalcemia ； pregnancy

國際替代計量

Primary Hyperparathyroidism in Pregnancy: A Case Report

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