Severe Primary Hyperparathyroidism Revealed by Hypercalcemic Crisis and Acute Pancreatitis in Late Pregnancy: A Case Report and Multidisciplinary Management Approach

Primary hyperparathyroidism (PHPT) during pregnancy is a rare but potentially life-threatening condition that can lead to severe maternal and fetal complications if unrecognized. We report the case of a 36-year-old pregnant woman at 33 weeks’ gestation who presented with acute confusion and was found to have severe hypercalcemia. Further evaluation revealed markedly elevated parathyroid hormone levels, consistent with PHPT, along with acute pancreatitis and extensive osteolytic bone lesions. Due to fetal distress and uterine contractions, an emergency cesarean delivery was performed. The neonate required admission to neonatal intensive care but had a favorable outcome. The mother’s hypercalcemia was managed with intensive intravenous hydration, diuretic therapy, hemodialysis, and postpartum administration of zoledronic acid. Imaging revealed a parathyroid adenoma, and endocrinologic workup confirmed severe PHPT with associated vitamin D deficiency. The patient was referred for further investigation to rule out a multiple endocrine neoplasia (MEN) syndrome and to prepare for parathyroidectomy. This case highlights the diagnostic and therapeutic challenges of PHPT during pregnancy, especially when complicated by acute pancreatitis and neuropsychiatric symptoms. It emphasizes the critical need for multidisciplinary collaboration across obstetrics, endocrinology, intensive care, nephrology, neonatology, and surgery. Given the absence of formal obstetric guidelines for PHPT, individualized management strategies based on clinical presentation and gestational age are essential. Early recognition and prompt intervention are key to preventing serious outcomes. This case adds to the limited literature on late-pregnancy PHPT and demonstrates that even severe metabolic emergencies in pregnancy can be successfully managed through vigilant monitoring and coordinated care.