Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2018; 6(11): 466-471
Published online Oct 6, 2018. doi: 10.12998/wjcc.v6.i11.466
Twin pregnancy with triple parathyroid adenoma: A case report and review of literature
Yu Zhang, Jin-Wang Ding, Ling-Ying Yu, Ding-Cun Luo, Jian-Liang Sun, Zhi-Kai Lei, Zhi-Hua Wang
Yu Zhang, Jin-Wang Ding, Ding-Cun Luo, Department of Oncology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Ling-Ying Yu, Department of Endocrinology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Jian-Liang Sun, Department of Anesthesiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Zhi-Kai Lei, Department of Ultrasound Branch, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Zhi-Hua Wang, Department of Obstetrics and Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Author contributions: Luo DC was accountable for the execution of the case report and the integrity and analysis of the data; Ding JW, Lei ZK, Sun JL, Wang ZH and Yu LY collected patient’s clinical data; Zhang Y, Ding JW and Yu LY analyzed the data and wrote the paper; all authors read and approved the final manuscript.
Supported by the Key Project of Scientific and Technological Innovation in Hangzhou, NO. 20131813A08; the Key Project of Medical Scientific and Technology Program in Hangzhou, NO. 2013Z04; the Traditional Chinese Medical Science Research Program of Zhejiang Province, NO. 2018239534; the Applied Research Project of Commonweal Technology in Zhejiang Province, NO. 2017C33180.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ding-Cun Luo, MD, Chief Doctor, Professor, Surgeon, Department of Oncology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, No. 261 Huansha Road, Hangzhou 310006, Zhejiang Province, China. ldc65@163.com
Telephone: +86-571-56006981 Fax: +86-571-87914773
Received: June 21, 2018
Peer-review started: June 21, 2018
First decision: July 8, 2018
Revised: July 20, 2018
Accepted: August 6, 2018
Article in press: August 6, 2018
Published online: October 6, 2018
Processing time: 99 Days and 16 Hours
Abstract

Primary hyperparathyroidism (PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.

Keywords: Primary hyperparathyroidism; Pregnancy; Triple parathyroid adenoma; Surgery

Core tip: Primary hyperparathyroidism (PHPT) during pregnancy is rare and has been previously reported, but a case of PHPT in a twin pregnancy with three parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, and pregnant women who insist upon continuing a pregnancy are not suitable to undergo 99mTc-sestamibi scintigraphy. These results in a case of PHPT that is easily misdiagnosed and can have serious consequences for the patient and the fetus. Therefore, we reviewed the difficulties encountered during the diagnosis and treatment of this case to improve the understanding of this disease and reduce the incidence of incorrect and missed diagnoses.