Severe primary hyperparathyroidism with extensive brown tumours and multiple fractures in pregnancy

Primary hyperparathyroidism during pregnancy is rare but can lead to severe complications especially if the diagnosis is delayed. Herein, we present the case of a pregnant woman in her 30s (32 weeks’ gestation) with severe hypercalcaemia, skeletal brown tumours and pathological fractures. Initial management with fluids, calcitonin and cinacalcet was inadequate in controlling the hypercalcaemia. She required urgent parathyroidectomy, and this was completed successfully at 33 weeks’ gestation. A large single adenoma was removed, which was benign on histology. Postoperative complications included hungry bone syndrome and transient neonatal hypoparathyroidism, which resolved within 3 months.