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Hyperparathyroidism / Hypocalcemia in Pregnancy

A 29-year-old at 20 weeks presents with hypercalcemia (Ca 12.8), nephrolithiasis, and polyuria. Another patient at 28 weeks with hypocalcemia has carpopedal spasms, QT prolongation, Ca 6.5. Outline management strategies.

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Coordinate delivery with endocrinology; neonatal Ca monitoring postpartum (risk hypocalcemia if maternal hyperparathyroid)

Hydration + loop diuretics; if Ca >11.5 with symptoms: parathyroidectomy safest in 2nd trimester

Symptomatic hypocalcemia: IV calcium gluconate; oral Ca + vitamin D for chronic management

Serial calcium, Mg, phosphate, fetal growth scans

Hyperparathyroidism in pregnancy ↑ risk nephrolithiasis, pancreatitis, IUGR, preeclampsia; hypocalcemia can cause seizures/arrhythmias

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