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A metabolic complication of pregnancy

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A 32 year old pregnant woman (gravida 3, para 1) was referred to the antenatal booking clinic at 12 weeks. She had recently been found to be hypertensive by her general practitioner, and her blood pressure was 150/100 mm Hg. Treatment was started with methyldopa. Ultrasound showed a normally grown fetus. A renal ultrasound examination was abnormal (fig1). She had symptoms of tiredness and nausea attributed to her pregnancy. There was no history of abdominal pain, renal colic, muscle cramps, arthralgia, or polyuria and she was not taking any drugs apart from methyldopa. There was no family history of endocrine disease. Her mother suffered from hypertension, and the patient herself had been hypertensive during the last few weeks of her previous pregnancy in 1994. This resolved following delivery.

Full blood count, renal function, urate, thyroid function, serum magnesium, and urine microscopy were normal. Serum calcium was 3.47 mmol/l (normal 2.0–2.6 mmol/l), serum phosphate 0.64 mmol/l (0.8–1.2 mmol/l), and serum parathormone 15 ng/l (2–6 ng/l); 24 hour urinary catecholamine excretion was normal. Ultrasound of the parathyroids is shown in fig2.

Figure 2

Parathyroid ultrasound examination.

Questions

(1)
What are the findings on the ultrasound in figs 1 and 2?
(2)
How should this patient be managed?
Figure 1

Renal ultrasound examination.

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