Hyperemesis gravidarum door primaire hyperparathyreoïdie

A 30-year-old primigravida consulted a gynaecologist at 12 weeks and 5 days of amenorrhoea with symptoms of nausea, vomiting, and dehydration. Initially the patient was treated for hyperemesis gravidarum, but the complaints persisted. Additional investigation showed an elevated serum calcium concentration on 2 occasions (3.27 and 3.17 mmol/l), while the albumin concentration was not abnormal (33 g/l) and the concentration of parathormone was raised (20.1 pmol/l). An ultrasound scan of the neck revealed a hypoechoic abnormality, compatible with a parathyroid adenoma. A few days later, following rehydration, the patient underwent parathyroidectomy, after which there was a return to normocalcaemia and the symptoms disappeared. Pathological examination confirmed the adenoma. She delivered a healthy infant at term. Routine measurement of serum calcium concentration in any patient with hyperemesis gravidarum is advisable. If this level is elevated, further diagnostic investigations should be performed.