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Primary hyperparathyroidism is a relatively common condition, being the third most common endocrine disorder after diabetes and thyroid disease. It is most often seen in patients in their 50s and 60s, but it can occur in juveniles, although rarely, when the diagnosis may be delayed. In women of childbearing age, there is an estimated incidence of 8 per 100 000 population per year. Pregnant patients with primary hyperparathyroidism may be asymptomatic or have subtle symptoms such as fatigue, thirst, constipation, or transient depression. These are common complaints in the general population and pregnant patients may attribute them to pregnancy. We describe two patients, seen within one year, in whom primary hyperparathyroidism was diagnosed after convulsions in their infants. Large parathyroid adenomas were localised in both patients by using technetium sestamibi scanning, and these were surgically removed.
A 33 year old multiparous woman with no major medical history delivered a girl weighing 3200 g by spontaneous vertex delivery at 39 weeks' gestation. Her first child had been born three years earlier. The baby was referred to hospital at five days of age with projectile vomiting for 12 hours. A feeding test for pyloric stenosis gave negative results. On the third day of admission the infant had a major convulsion. An infection screen gave negative results.
Routine blood tests showed a low corrected serum calcium concentration of 1.32 mmol/l (normal range …