Hyperemesis Gravidarum Revealing Primary Hyperparathyroidism

Primary hyperparathyroidism is among the most common endocrinopathy in the general population. However, this entity is rare in women of childbearing age, and even rarer during pregnancy. Patients with hyperparathyroidism have a highly aspecific symptomatology, with symptoms as those found physiologically in pregnant women during the first trimester, making the diagnosis difficult to identify. Furthermore, calcemia assessment is not usually performed during routine pregnancy follow-up. Thus, primary hyperparathyroidism with severe hypercalcemia is at high risk of being left untreated during pregnancy, a situation that could lead to serious complications. There are not only obstetrical complications but also fetal complications such as neonatal hypocalcemia. During pregnancy, not many treatments are allowed such as Zoledronate due to the lack of information concerning its effects on the fœtus. On the other hand, some treatments may not be as efficient as the 7/8th parathyroidectomy, which remains the treatment of choice for symptomatic pregnant patients with primary hyperparathyroidism due to parathyroid hyperplasia with very high blood calcium levels. This article presents the case of a 28-year-old woman who was initially admitted for hyperemesis gravidarum. The lack of clinical improvement led us to further our research. Not only did we diagnose a primary hyperparathyroidism due to parathyroid hyperplasia but we also discovered that she had developed central pontine myelinosis probably because of refractory hypokaliemia related to hypercalcemia, making this case a real challenge.