原发性甲状旁腺功能亢进症(primary hyperparathyroidism，PHPT) 是由于甲状旁腺产生过多的甲状旁腺激素所致，妊娠期间首次发现的PHPT十分罕见，且对母体和胎儿有严重不良影响。本文报告了一例妊娠合并PHPT、高钙危象、急性胰腺炎的病例，患者行急诊剖宫产术，产后第47天行甲状旁腺腺瘤切除术，所娩出胎儿在分娩后曾有数次低钙抽搐。产后9个月随访时患者恢复良好，婴儿生长发育良好。本例患者为30岁妊娠期女性，孕32周时因腹痛、呕吐就诊，实验室检查提示血钙3.56 mmol/L、甲状旁腺激素(parathyroid hormone，PTH)388.6 ng/L，影像学检查证实急性胰腺炎及甲状旁腺占位。值得注意的是，患者分娩后PTH水平较产前明显下降(48.91~53.08 ng/L)，结合术后病理所见腺瘤内出血及含铁血黄素沉积，分析可能与急性胰腺炎期间有效循环血容量减少及瘤体部分缺血坏死有关。临床医师应提高对于妊娠合并PHPT的警惕性，特别是孕前检查及孕早期应当注意血钙水平，并尽早采取预防措施以避免并发症及不良妊娠结局的发生。

Primary hyperparathyroidism (PHPT) is caused by excessive production of parathyroid hormone by the parathyroid gland. PHPT discovered for the first time during pregnancy is extremely rare and has serious adverse effects on both the mother and the fetus. This article reports a case of pregnancy complicated by PHPT, hypercalcemic crisis, and acute pancreatitis. The patient was a 30-year-old woman at 32 weeks of gestation who presented with a four-day history of progressive abdominal pain and vomiting. Laboratory evaluation on admission revealed a markedly elevated serum total calcium of 3.56 mmol/L and a parathyroid hormone (PTH) level of 388.6 ng/L, with the normal reference range being 15 to 65 ng/L. Imaging studies confirmed the presence of acute pancreatitis, left nephrolithiasis, right hydronephrosis, and a suspicious cystic-solid mass at the lower pole of the right thyroid lobe measuring 2.1 cm × 2.0 cm × 1.2 cm. Due to rapid clinical deterioration and the development of a hypercalcemic crisis, an emergency cesarean section was performed, resulting in the delivery of a live premature male infant with a birth weight of 2 400 g and a length of 45 cm. The neonate's initial serum calcium was 3.08 mmol/L, and several episodes of hypocalcemic seizures occurred shortly after birth, necessitating admission to the neonatal intensive care unit. Postpartum, the mother was managed with aggressive intravenous fluid resuscitation, subcutaneous calcitonin, and intravenous bisphosphonate therapy. Notably, her serum PTH level decreased substantially after delivery, ranging from 48.91 to 53.08 ng/L. This spontaneous decline was likely attributable to reduced effective circulating blood volume during the episode of acute pancreatitis and partial ischemic necrosis of the parathyroid adenoma. At 47 days postpartum, the patient underwent successful surgical resection of a right inferior parathyroid adenoma measuring approximately 3 cm in diameter. Pathological examination of the resected specimen confirmed the diagnosis and revealed focal vascular proliferation and congestion, interstitial fibrosis with hyaline degeneration, and hemosiderin deposition. Following parathyroidectomy, her serum calcium and PTH levels normalized rapidly and remained stable. At the 9-month follow-up visit, the mother was completely asymptomatic with normal biochemical parameters, and the infant demonstrated appropriate growth and development. Clinicians should be vigilant about the presence of PHPT during pregnancy, especially during preconception and early pregnancy, monitoring blood calcium levels and taking preventive measures early to avoid complications and adverse pregnancy outcomes.

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作者贡献声明  谢晓琪、王相清、刘蔚：收集数据，撰写论文；张秀英、陈玲、张放、张瑞：收集数据；纪立农、韩学尧、刘蔚：总体把关和审定论文。所有作者均参与论文修改，并对最终文稿进行审读和确认。