Surgical parathyroidectomy in pregnancy for severe secondary hyperparathyroidism associated with end-stage kidney disease

Secondary hyperparathyroidism (SHPT) is common in patients with end-stage kidney disease (ESKD) on kidney replacement therapy, which leads to abnormalities of bone and mineral metabolism. Patients conceiving on kidney replacement therapy add a further layer of complexity to the management of their SHPT. Existing literature in cases of primary hyperparathyroidism (PHPT) has linked untreated hyperparathyroidism to increased maternal and fetal morbidity, including hypertensive disorders of pregnancy, fetal growth restriction and neonatal hypocalcaemia. The pharmacotherapies used for SHPT lack the safety data in pregnancy and may not adequately control severe disease. Existing literature on surgical parathyroidectomy in pregnancy is limited to the cases of PHPT. We present a case of a multigravida woman with ESKD on haemodialysis, who conceived with severe pre-existing SHPT. We describe the success of surgical parathyroidectomy in pregnancy to treat her SHPT despite the limited evidence supporting this treatment.