A case of pregnancy with a uterine fibroid produced parathyroid hormone related protein

• Published in: Journal of Japan Society of Perinatal and Neonatal Medicine Vol. 60; no. 2; pp. 250 - 255
• Main Authors: Arahori, Kenji, Tannaka, Shiori, Hayashi, Kana, Takatsuji, Noriko, Kato, Yuichiro
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Perinatal and Neonatal Medicine 2024; 一般社団法人 日本周産期・新生児医学会
• Subjects: fibroids; hypercalcemia; pregnancy; PTHrP
• ISSN: 1348-964X; 2435-4996
• DOI: 10.34456/jjspnm.60.2_250

A 30-year-old primigravid, nulliparous woman was diagnosed with uterine fibroid 6 cm in diameter, and had been followed up. She became pregnant by embryo transplantation and was referred to our hospital at the 7th week of gestation. She was admitted at 13 weeks and 3 days of pregnancy due to hyperemesis, and an abnormally high blood Ca level of 16.0 mg/dL. Because of a low intact-parathyroid hormone（PTH）and high parathyroid hormone-related peptide（PTHrP）and 1, 25-dihydroxyvitamin D levels, a PTHrP-producing tumor was suspected. We did not find malignant PTHrP-producing tumor. Although the blood Ca level decreased by fluid replacement, it increased again with mild impairment of renal function. As the uterine fibroid was suspected to be a PTHrP-producing tumor, abdominal myomectomy was performed at 15 weeks and 5 days of pregnancy. Both the Ca and PTHrP levels decreased on day 1 after surgery with relief of symptoms, and she was discharged. Histopathological examination indicated uterine leiomyoma accompanied by liquefaction degeneration, and the uterine fibroid was diagnosed by immunostaining as a PTHrP-producing tumor. Since uterine fibroid producing PTHrP tumor is rare, the case is reported with a review of the literature.