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Chandran M, Tse Tan SY. Disorders of bone and mineral metabolism in pregnancy and lactation: A case based clinical review. Osteoporos Sarcopenia 2025; 11:1-8. [PMID: 40256359 PMCID: PMC12009114 DOI: 10.1016/j.afos.2025.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 03/01/2025] [Accepted: 03/08/2025] [Indexed: 04/22/2025] Open
Abstract
Bone and mineral metabolism in the human body undergoes significant adaptations during pregnancy and lactation to meet the physiological demands of both the mother and fetus. The growing fetus requires approximately 30 g of calcium, with 80% of this transferred from the mother during the third trimester. These adaptations involve complex hormonal changes, such as increased parathyroid hormone-related peptide (PTHrP) and 1,25-dihydroxyvitamin D, ensuring the mother maintains calcium balance despite fetal demands. However, these changes can also exacerbate pre-existing metabolic bone disorders, presenting unique challenges during pregnancy. This narrative review, framed around illustrative case examples, focuses on the management of metabolic bone disorders in pregnancy. Relevant case studies of hypercalcemia, hypocalcemia, hypophosphatemia, and osteoporosis and chronic kidney disease mineral bone disorder are reviewed to illustrate the biochemical changes, clinical implications, and therapeutic strategies available during pregnancy and lactation. We analyze literature from case reports and existing guidelines to provide practical clinical recommendations. The review highlights critical pregnancy-related metabolic adaptations, such as increased intestinal calcium absorption and skeletal resorption. Disorders like primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalcemia present significant maternal and fetal risks, including miscarriage, growth restriction, and neonatal complications. Early identification and tailored treatment, including hydration, parathyroidectomy, and vitamin D supplementation, mitigate these risks, with surgical interventions in PHPT improving pregnancy outcomes compared to conservative management. Management of metabolic bone disorders during pregnancy and lactation requires a nuanced approach to meet the dual needs of the mother and fetus.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore
| | - Sarah Ying Tse Tan
- Obesity and Metabolic Unit, Department of Endocrinology, Singapore General Hospital, Singapore
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Luong TV, Le LD, Nguyen NVD, Dang HNN. Persistent challenges in the diagnosis of acute pancreatitis due to primary hyperparathyroidism during pregnancy. World J Gastroenterol 2025; 31:100973. [PMID: 39991684 PMCID: PMC11755251 DOI: 10.3748/wjg.v31.i7.100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 12/01/2024] [Accepted: 01/02/2025] [Indexed: 01/20/2025] Open
Abstract
In this manuscript, we provide critical commentary on the systematic review by Augustin et al, which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy. Although this is an infrequent complication, it poses severe risks to both maternal and fetal health. Due to its infrequent occurrence in clinical practice, this review is based on an analysis of individual case reports over the past 55 years. While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis, it is unique in that it has a sufficiently large sample size with statistically significant results. Our discussion focuses on the diagnostic challenges associated with this condition, which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels. We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.
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Affiliation(s)
- Thang Viet Luong
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue 530000, Viet Nam
| | - Linh Duy Le
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue 530000, Viet Nam
| | - Nam Van Duc Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue 530000, Viet Nam
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Sabbah N. Acute hypercalcemic crisis: A narrative review with a focus on pregnancy. ANNALES D'ENDOCRINOLOGIE 2024; 85:604-613. [PMID: 38880126 DOI: 10.1016/j.ando.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 06/18/2024]
Abstract
A hypercalcemic crisis is a rare therapeutic emergency. However, it should not be overlooked, particularly during pregnancy, as it is associated with significant maternal and fetal morbidity and mortality. The most frequent etiology, including in pregnant women, is primary hyperparathyroidism. Knowledge of calcium-phosphate metabolism during pregnancy is important for understanding and interpreting the clinicopathological abnormalities observed in parathyroid pathology. Despite the expert consensus statement on parathyroid pathology issued by the European Society of Endocrinology, management of hypercalcemic crises remains poorly codified, particularly in pregnant women. Diagnostic examinations and hypocalcemia treatments are generally not recommended during pregnancy; however, it may be necessary to optimize preparation for surgery. Notably, surgery is the treatment of choice, particularly during pregnancy, when it should ideally be performed during the 2nd trimester. Therefore, a multidisciplinary approach is necessary. A consensus among European experts recommends systematic early detection of hypercalcemia during early pregnancy.
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Affiliation(s)
- Nadia Sabbah
- Endocrinology Diabetology and Nutrition Department, Centre Hospitalier de Cayenne, avenue des Flamboyants, 97300 Cayenne, French Guiana.
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Eli S, Gal SG, Adnan Z. Comparison between surgical and non-surgical management of primary hyperparathyroidism during pregnancy: a systematic review. Endocrine 2024; 86:101-108. [PMID: 38918290 PMCID: PMC11445326 DOI: 10.1007/s12020-024-03930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE The management of primary hyperparathyroidism (PHPT) during pregnancy may be surgical or conservative. This study compared adverse outcomes between surgical and non-surgical treatments. Additionally, the study investigated the correlation between serum calcium values and complication rates. METHODS A systematic review of retrospective studies, case series, and case reports. Biochemical parameters, interventions, and outcomes of each pregnancy were recorded. The study population comprised two groups: the non-surgical and surgical groups. Adverse outcomes were categorized as maternal, obstetric, or neonatal. RESULTS The surgical and non-surgical groups consisted of 163 and 185 patients, respectively. A positive correlation was observed between the mean maternal gestational calcium value and both maternal and obstetric complication. Neonatal complications were more prevalent in patients treated conservatively across all maternal calcium values (p < 0.001). No significant differences were observed in maternal outcomes and overall obstetric outcomes between the study groups, albeit a higher mean serum calcium value in the surgical group (12.3 mg/dL) compared with the non-surgical group (11.1 mg/dL). CONCLUSIONS Given the significantly lower neonatal adverse outcomes in the surgical group compared to the non-surgical group, along with non-inferior maternal and obstetric outcomes in the surgical group, the overall data of this study suggest that parathyroidectomy is favorable to non-surgical management even in cases of mild hypercalcemia.
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Affiliation(s)
- Shezifi Eli
- Bar-Ilan University, The Azrieli Faculty of Medicine, Safed, Israel
- Laniado Hospital, Netanya, Israel
| | - Shlomo Gozlan Gal
- Department of Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zaina Adnan
- Bar-Ilan University, The Azrieli Faculty of Medicine, Safed, Israel.
- Division of Endocrinology and Metabolism, Clalit Medical Health Care Services, Haifa and Western Galilee District, Zvulon Medical Center, Haifa, Israel.
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Beck AJ, Reddy VM, Sulkin T, Browne D. Management of severe and symptomatic primary hyperparathyroidism in the first trimester of unplanned pregnancy. Endocrinol Diabetes Metab Case Rep 2022; 2022:21-0203. [PMID: 36070416 PMCID: PMC9513675 DOI: 10.1530/edm-21-0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/17/2022] [Indexed: 11/08/2022] Open
Abstract
Summary Primary hyperparathyroidism (PHP) is the most common aetiology for hypercalcaemia. The incidence of PHP in pregnant women is reported to be 8/100 000 population/year. It presents a threat to the health of both mother (hyperemesis, nephrolithiasis) and fetus (fetal death, congenital malformations, and neonatal severe hypocalcaemia-induced tetany). However, there is a lack of clear guidance on the management of primary hyperparathyroidism in pregnancy. In this study, we describe the case of a 26-year-old female patient who presented with severe hypercalcaemia secondary to PHP and underwent successful parathyroid adenectomy under local anaesthesia. Learning points Primary hyperparathyroidism is a rare complication in pregnancy, but the consequences for mother and fetus can be severe. A perceived risk of general anaesthesia to the fetus in the first trimester has resulted in a general consensus to delay parathyroid surgery to the second trimester when possible - although the increased risk of fetal loss may occur before planned surgery. If the patient presents with severe or symptomatic hypercalcaemia, minimally invasive surgery under local anaesthetic should be considered regardless of the gestational age of the pregnancy.
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Affiliation(s)
- Adele J Beck
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Venkat M Reddy
- Royal Cornwall Hospitals NHS Trust, Endocrinology and Diabetes Mellitus, Treliske, Truro, UK
| | - Tom Sulkin
- Royal Cornwall Hospitals NHS Trust, Endocrinology and Diabetes Mellitus, Treliske, Truro, UK
| | - Duncan Browne
- Royal Cornwall Hospitals NHS Trust, Endocrinology and Diabetes Mellitus, Treliske, Truro, UK
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Hyperparathyroidism in Pregnancy: A Review of the Literature. Obstet Gynecol Surv 2022; 77:35-44. [PMID: 34994393 DOI: 10.1097/ogx.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Maternal hyperparathyroidism can be associated with significant maternal and fetal morbidity and fetal mortality. Because the maternal symptoms are typically nonspecific, the disorder may not be recognized leading to adverse pregnancy outcomes. Objective The aim of this study was to review the literature on the etiology/prevalence, pathophysiology, diagnosis, management (medical and surgical), and the maternal/neonatal complications associated with pregnancies complicated by hyperparathyroidism. Evidence Acquisition A literature search was undertaken by our university librarian using the search engines PubMed and Web of Science. Search terms used included "hyperparathyroidism" AND "pregnancy" OR "pregnancy complications" OR "maternal." The number of years searched was not limited, but the abstracts had to be in English. Results There were 309 abstracts identified, 164 of which are the basis of this review. This includes 137 articles of the 269 individual case reports in the literature since the first case report in 1947. The articles and case reports reviewed the etiology, risk factors, diagnosis, management, complications, and maternal/fetal outcomes of pregnancies complicated by hyperparathyroidism. Conclusions and Relevance Undiagnosed maternal hyperparathyroidism can result in critical maternal and fetal outcomes during pregnancy. This review highlights what is currently known about hyperparathyroidism during pregnancy to increase the awareness of this serious pregnancy disorder.
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Pliakos I, Chorti A, Moysidis M, Kotsovolis G, Kaltsas T, Pana A, Ioannidis A, Papavramidis TS. Parathyroid adenoma in pregnancy: A case report and systematic review of the literature. Front Endocrinol (Lausanne) 2022; 13:975954. [PMID: 36325457 PMCID: PMC9618884 DOI: 10.3389/fendo.2022.975954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Primary hyperparathyroidism is a common disorder of the parathyroid glands. Parathyroid adenoma (PA) in pregnancy is a relatively rare disease, whose diagnosis and treatment is a challenging task. The aim of the present study is to present a new case of parathyroid adenoma during pregnancy and to give a detailed account of all reported cases of parathyroid adenoma during pregnancy in the literature. STUDY DESIGN A bibliographic research was performed, and characteristics of parathyroid adenomas in pregnancy such as age, gestational week at diagnosis, ionized calcium levels, genetic testing result, symptomatology, radiological method of localization, treatment method, gestational week at operation, and maternal/fetal complications were recorded. RESULTS A 34-year-old woman at her 25 weeks' gestation was diagnosed with parathyroid adenoma and was referred to our Surgical Department due to contraindication for conservative treatment. A parathyroidectomy was performed, and the maternal and fetal postoperative period was uneventful. Two hundred eleven cases of parathyroid adenoma in pregnancy were recorded in the literature, and statistical analysis was performed. The median gestational week at diagnosis was 21 ± 9.61 weeks. The mean level of ionized calcium was 2.69 mmol/l [SD = 0.75 (2.55-2.84 95% CI)]. Most cases were familiar (72.4%), while surgery was the preferred treatment option (67.3%). The majority of cases were asymptomatic (21.7%), and the main radiological method applied for localization was ultrasound (63.4%). CONCLUSION Parathyroid adenoma in pregnancy is a rare condition. The early diagnosis is of great importance as surgical treatment at the second trimester of pregnancy outweighs the maternal and fetal risks.
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Affiliation(s)
- I. Pliakos
- Department of Minimal Invasive Endocrine Surgery, Kyanous Stavros, Euromedica Clinic, Thessaloniki, Greece
| | - A. Chorti
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Moysis Moysidis
- Department of Minimal Invasive Endocrine Surgery, Kyanous Stavros, Euromedica Clinic, Thessaloniki, Greece
| | - G. Kotsovolis
- Department of Minimal Invasive Endocrine Surgery, Kyanous Stavros, Euromedica Clinic, Thessaloniki, Greece
| | - T. Kaltsas
- Department of Minimal Invasive Endocrine Surgery, Kyanous Stavros, Euromedica Clinic, Thessaloniki, Greece
| | - A. Pana
- 1st Department of Obstetrics and Gynecology, Papageorgiou Hospital, Faculty of Health Science, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A. Ioannidis
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - TS. Papavramidis
- Department of Minimal Invasive Endocrine Surgery, Kyanous Stavros, Euromedica Clinic, Thessaloniki, Greece
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Faculty of Health Science, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- *Correspondence: TS. Papavramidis,
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Nastos C, Paspala A, Mavroeidi I, Stavratis F, Lampadiari V, Kalantaridou S, Peppa M, Pikoulis E. Surgical management of primary hyperparathyroidism during pregnancy: a systematic review of the literature. Gynecol Endocrinol 2021; 37:1086-1095. [PMID: 34044722 DOI: 10.1080/09513590.2021.1932801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Gestational primary hyperparathyroidism (PHPT) is an endocrinological disorder with serious outcomes for both women and neonates. The aim of our study was to present the current evidence concerning the perioperative outcomes of pregnant women with PHPT who underwent parathyroidectomy during pregnancy. METHODS A meticulous systematic review of the literature published before February 2020 and all studies which presented perioperative and pregnancy outcomes off pregnant women who underwent parathyroidectomy for PHPT, were included. RESULTS A total of 53 were finally included, which reported 92 pregnant women who had parathyroidectomy during their pregnancy. A total of 46 patients were hospitalized due to significant complications of PHPT before their parathyroidectomy. With regards to surgical approach, 52.2% of patients underwent minimally invasive parathyroidectomy (MIP), while bilateral neck exploration (BNE) was 41.3% of cases. Only 4 women was not cured, whereas transient hypocalcemia was occurred in 18 patients. All cases proceeded to deliveries of healthy neonates, after their parathyroidectomy. CONCLUSIONS Parathyroidectomy during pregnancy is a safe and effective treatment option with minimum complications and probably should be considered as the treatment of choice in specific group of pregnant women with PHPT.
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Affiliation(s)
- Constantinos Nastos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Anna Paspala
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Ioanna Mavroeidi
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine & Research Institute, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Fotios Stavratis
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Vaia Lampadiari
- 2nd Propaedeutic Department of Internal Medicine & Research Institute, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Sophia Kalantaridou
- 3rd Department of Gynaecology and Obstetrics, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Melpomeni Peppa
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine & Research Institute, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Emmanuil Pikoulis
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management. J Clin Med 2021; 10:jcm10132956. [PMID: 34209340 PMCID: PMC8268799 DOI: 10.3390/jcm10132956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Parathyroid disease is uncommon in pregnancy. During pregnancy, multiple changes occur in the calcium regulating hormones which may make the diagnosis of primary hyperparathyroidism more challenging. Close monitoring of serum calcium during pregnancy is necessary in order to optimize maternal and fetal outcomes. In this review, we will describe the diagnosis and management of primary hyperparathyroidism during pregnancy. Methods: We searched MEDLINE, CINAHL, EMBASE and Google scholar bases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters and clinical guidelines were included in this review. Conclusions: Medical management options for primary hyperparathyroidism during pregnancy are severely limited due to inadequate safety data with the various potential therapies available, and surgery is advised during the 2nd trimester of pregnancy in the presence of severe hypercalcemia (calcium adjusted for albumin greater than 3.0 mmol/L (12.0 mg/dL)). Hypercalcemia should be avoided during pregnancy in order to minimize maternal and fetal complications.
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Tsourdi E, Anastasilakis AD. Parathyroid Disease in Pregnancy and Lactation: A Narrative Review of the Literature. Biomedicines 2021; 9:475. [PMID: 33925967 PMCID: PMC8145477 DOI: 10.3390/biomedicines9050475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
Pregnancy and lactation are characterized by sophisticated adaptations of calcium homeostasis, aiming to meet fetal, neonatal, and maternal calcium requirements. Pregnancy is primarily characterized by an enhancement of intestinal calcium absorption, whereas during lactation additional calcium is obtained through resorption from the maternal skeleton, a process which leads to bone loss but is reversible following weaning. These maternal adaptations during pregnancy and lactation may influence or confound the presentation, diagnosis, and management of parathyroid disorders such as primary hyperparathyroidism or hypoparathyroidism. Parathyroid diseases are uncommon in these settings but can be severe when they occur and may affect both maternal and fetal health. This review aims to delineate the changes in calcium physiology that occur with pregnancy and lactation, describe the disorders of calcium and parathyroid physiology that can occur, and outline treatment strategies for these diseases in the above settings.
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Affiliation(s)
- Elena Tsourdi
- Center for Healthy Aging, Department of Medicine III, Technische Universität Dresden Medical Center, 01307 Dresden, Germany
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Abusabeib A, Bhat H, El Ansari W, Al Hassan MS, Abdelaal A. Right ectopic paraesophageal parathyroid adenoma with refractory hypercalcemia in pregnancy: A case report and review of the literature. Int J Surg Case Rep 2020; 77:229-234. [PMID: 33221566 PMCID: PMC7689332 DOI: 10.1016/j.ijscr.2020.10.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022] Open
Abstract
Ectopic parathyroid adenoma (EPA) is rare during pregnancy but poses multiple challenges in diagnosis and treatment. EPA presents with refractory hypercalcemia which leads to symptoms and complications in the mother and fetus. Preoperative localization of EPA is important and allows for a focused surgical procedure. Surgery is a definitive treatment and can safely be performed during the 2nd trimester of pregnancy. Introduction Ectopic parathyroid adenoma is rare during pregnancy but poses multiple challenges in treatment. It presents as primary hyperparathyroidism which leads to symptoms and complications of hypercalcemia in both the mother and fetus. Presentation of case A 38-year-old Sudanese female presented with diffuse bone pain and polyuria. Laboratory investigations revealed elevated serum calcium and parathyroid hormone. Ultrasound of the neck did not show any abnormal lesion, however 99mTc-sestamibi scan showed a right sided parathyroid adenoma, and an earlier CT scan showed the adenoma to be in an ectopic paraesophageal position. Focused surgical neck exploration was done, and the ectopic parathyroid adenoma was excised. Discussion Preoperative localization of the ectopic parathyroid adenoma allows for a focused surgical procedure. Ultrasound is the safest during pregnancy, but 99mTc-sestamibi and CT scan may be necessary if ultrasound or initial bilateral neck exploration do not detect any adenoma. Mild elevations in maternal serum calcium can have detrimental effects on the fetus which suggests that a surgical approach may be necessary in the majority of cases. Conclusions Ectopic parathyroid adenoma is rare during pregnancy and is detrimental to both the mother and fetus. Preoperative localization allows for a focused surgery which is a definitive treatment and can safely be performed during the 2nd trimester of pregnancy.
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Affiliation(s)
- Abdelrahman Abusabeib
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Harun Bhat
- Weill Cornell Medicine in Qatar, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden.
| | - Mohamed S Al Hassan
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdelrahman Abdelaal
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Abstract
Although uncommon in pregnancy, parathyroid dysfunction may produce significant perinatal and maternal morbidity and mortality. The prevalence of hyperparathyroidism is 0.5%. The most common cause of primary hyperparathyroidism in pregnancy is a single parathyroid adenoma, which is present in nearly 80% of cases. Surgery is the only definitive treatment for primary hyperparathyroidism, with a cure rate that is excellent. The most common etiology of hypoparathyroidism is damage to the parathyroid glands after surgery, with an incidence of 0.2%. Treatment of hypoparathyroidism is usually a high-calcium diet with vitamin D supplementation. Vitamin D deficiency is common, associated with perinatal morbidity and easily corrected.
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13
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Sharma SG, Levine SN, Yatavelli RK, Shaha MA, Nathan CAO. Parathyroidectomy in First Trimester of Pregnancy. J Endocr Soc 2020; 4:bvaa015. [PMID: 32133431 PMCID: PMC7049289 DOI: 10.1210/jendso/bvaa015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Indexed: 11/24/2022] Open
Abstract
Primary hyperparathyroidism is not commonly diagnosed during pregnancy. For pregnant women with mild, asymptomatic disease, surgery can be avoided unless the degree of hypercalcemia becomes more severe or they develop complications. However, there are no evidence-based guidelines to assist clinicians regarding the management of primary hyperparathyroidism during pregnancy. When surgery is deemed necessary during pregnancy, the second trimester is generally considered to be the optimal time. We report the case of a 31-year-old female G1P0 who presented at 6 weeks gestation with symptoms of nausea, vomiting, polyuria, and corrected calcium of 14.8 mg/dL. Due to the extreme degree of hypercalcemia and refractory to medical treatment, it was decided that surgery could not be delayed until the second trimester. At 7w3d gestational age the patient had resection of a 37 gram, 5 × 4 × 3 cm right inferior parathyroid adenoma.
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Affiliation(s)
- Sonia G Sharma
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Steven N Levine
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Rajini K Yatavelli
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Manish A Shaha
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Cherie Ann O Nathan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Haciyanlı M, Özlem Gür EÖ, Genç H, Gücek Haciyanlı S, Tatar F, Acar T, Karaisli S. Minimally invasive parathyroidectomy using intraoperative ultrasonographic localization for primary hyperparathyroidism in pregnancy: report of two cases. Turk J Surg 2019; 35:231-235. [PMID: 32550334 DOI: 10.5578/turkjsurg.4330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/08/2019] [Indexed: 11/15/2022]
Abstract
Primary hyperparathyroidism (pHPT) in pregnancy is a rare entity associated with increased maternal and fetal mortality and morbidity. Diagnosis of pHPT is challenging in pregnancy. Approximately 80% of the cases are asymptomatic, while the most common symptoms are nausea, vomiting, polyuria, polydypsia, and cloudy vision in symptomatic patients. Since the most common cause of pHPT in pregnancy is adenoma, such in the general population, focused anterior or lateral approach is recommended due to shorter operation time, less risk for the fetus, and lower complication risk. Performing intraoperative ultrasonography to do the incision just over the adenoma provides quicker access to the adenoma and intraoperative parathormone assay confirms the surgical cure. Laryngeal mask anesthesia causes lesser sore throat, laryngospasm, coughing, and rapid recovery as compared to endotracheal intubation anesthesia. This study aimed to present the management of two pregnant patients diagnosed with pHPT and who underwent minimally invasive parathyroidectomy under intraoperative ultrasonography and laryngeal mask anesthesia at the second trimester of gestation. To the best of our knowledge, parathyroidectomy under laryngeal mask anesthesia in pregnancy has never been described before.
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Affiliation(s)
- Mehmet Haciyanlı
- Clinic of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Emine Özlem Özlem Gür
- Clinic of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Hüdai Genç
- Clinic of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Selda Gücek Haciyanlı
- Clinic of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Fatma Tatar
- Clinic of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Turan Acar
- Clinic of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Serkan Karaisli
- Clinic of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Stahl J, Winters N, Shariff A. A RARE CASE OF PRIMARY HYPERPARATHYROIDISM, HYPEREMESIS GRAVIDARUM, AND WERNICKE ENCEPHALOPATHY. AACE Clin Case Rep 2018; 5:e108-e111. [PMID: 31967013 DOI: 10.4158/accr-2018-0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 09/14/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To describe a rare case of Wernicke encephalopathy (WE) as a result of hyperemesis gravidarum due to primary hyperparathyroidism (PHPT) in pregnancy. Methods We present the clinical presentation, supportive laboratory values, diagnostic dilemmas, treatment, clinical outcome, and supportive literature review of a patient with WE as a result of hyperemesis gravidarum due to PHPT in pregnancy. Results A 27-year-old previously healthy G1P0 female presented with initial symptoms of right upper-quadrant pain, nausea, vomiting, and paresthesias at 17.3 weeks of gestation. The patient later developed neurologic symptoms including acute encephalopathy, ataxia, and intranuclear ophthalmoplegia. The suspicion for WE was confirmed with characteristic findings on brain magnetic resonance imaging. WE was attributed to severe malnutrition from hyperemesis gravidarum and poor prenatal care. Hypercalcemia with an elevated parathyroid hormone level was identified following an unfortunate intrauterine fetal demise, raising suspicion for PHPT. PHPT was confirmed, and after undergoing successful parathyroidectomy, the patient regained normal neurologic function, with the exception of mild lower-extremity paresthesias. Conclusion This case is an example where early recognition and treatment of hyperparathyroidism can be masked by severe malnutrition and present in an unusual way with neurologic symptoms of WE. Early recognition and suspicion are critical in preventing poor fetal outcomes and long-term consequences.
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Hu Y, Cui M, Sun Z, Su Z, Gao X, Liao Q, Zhao Y. Clinical Presentation, Management, and Outcomes of Primary Hyperparathyroidism during Pregnancy. Int J Endocrinol 2017; 2017:3947423. [PMID: 29147113 PMCID: PMC5632860 DOI: 10.1155/2017/3947423] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/26/2017] [Accepted: 08/08/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Primary hyperparathyroidism (pHPT) in pregnancy is a rare event, but it poses a significant risk to mothers and fetuses. The optimal treatment strategy remains controversial. METHODS We present a consecutive series of twelve pregnant women with pHPT. RESULTS Twelve women were diagnosed with pHPT during pregnancy or in the postpartum period. Four of them presented no symptoms or mild symptoms. Four patients experienced serious complications, including hypercalcaemic crisis, acute pancreatitis, and eclampsia. Another four patients were identified postpartum as the result of neonatal convulsion with hypocalcaemia. Minimally invasive parathyroidectomy (MIP) under cervical plexus block was successfully performed in 11 of them during pregnancy or postpartum. The serum levels of ionized calcium and intact parathyroid hormone (iPTH) were much higher in patients with severe complications in this cohort than those in the group of patients with no symptoms or mild symptoms and patients who were diagnosed postpartum. CONCLUSIONS MIP under cervical plexus block might be a safe and effective treatment for pregnant women with pHPT. Even though both conservative and surgical treatments are applicable for most mothers and fetuses with asymptomatic and mild hyperparathyroidism, serious complications may have catastrophic consequences for both.
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Affiliation(s)
- Ya Hu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ming Cui
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhengyi Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhe Su
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiang Gao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Primary hyperparathyroidism during pregnancy. Arch Gynecol Obstet 2014; 291:259-63. [PMID: 25367603 DOI: 10.1007/s00404-014-3526-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/21/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Primary hyperparathyroidism (pHPT) during pregnancy is rare and associated with increased morbidity and mortality for both mother and fetus. This review aims to draw together recent thinking on pregnancy and pHPT. METHODS We have performed a Pubmed (Medline(®)) search with no time limit using "primary hyperparathyroidism", "pregnancy" or "management" as keywords. We reviewed 37 articles in English and French languages on pHPT characteristics, clinical presentations, pregnancy complications, birth outcomes and management of pHPT during pregnancy. RESULTS The diagnosis of pHPT is characterized by an elevated serum calcium level associated with an inappropriate increase in the parathyroid hormone level. The clinical manifestations are directly related to the calcium level. Usual techniques to detect parathyroid adenoma or hyperplasia, as computerized tomography and 99mTc-sestamibi scintigraphy, are not recommended in pregnancy. Thus, ultrasonography of the neck is the current first-line investigation during pregnancy for localization of parathyroid diseases. pHPT during pregnancy with mildly elevated calcium levels may be managed with medical treatment: intravenous or oral rehydratation, with or without forced diuresis. Few drugs are available for pHTP during pregnancy; calcitonin and cinacalcet require further study; bisphosphonate should be restricted to life-threatening hypercalcemia. Surgery is the only curative treatment and is recommended when calcium levels are above 2.75 mmol/L. It should be performed in the second trimester and considered in the third trimester if there is inadequate response to medical therapy. CONCLUSION Early diagnosis of pHPT in a pregnant woman, followed by appropriate management and treatment, has been shown to significantly reduce maternal and fetal complications.
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Walker A, Fraile JJ, Hubbard JG. "Parathyroidectomy in pregnancy"-a single centre experience with review of evidence and proposal for treatment algorithim. Gland Surg 2014; 3:158-64. [PMID: 25207208 DOI: 10.3978/j.issn.2227-684x.2014.02.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/17/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND As many as 25% of women with primary hyperparathyroidism (PHPT) present during their child bearing years. However there is a paucity of data about management of PHPT in pregnancy, despite its association with severe complications including foetal loss. A recent review called for early surgical intervention to optimise maternal and foetal outcomes. We present our experience of parathyroidectomy in five pregnant patients, representing the largest series reported to date, alongside a review of literature to formulate a best evidence approach to management. METHODS A retrospective case series of five patients managed at a single tertiary referral centre in London, UK. Data analysed include patient demographics, clinical features, pre- and post-operative biochemical markers, pathology findings, surgical procedure, complications, and outcome of pregnancy. RESULTS Parathyroidectomy was safely carried out in all five patients during their second trimester. Cure was achieved by excision of adenoma in four patients at first operation with no reported complications. One patient with severe preoperative hypercalcaemia of >3 mmol/L suffered persistent severe hypercalcaemia despite three gland excision, with subsequent genetic testing revealing a mutation consistent with familial hypocalciuric hypercalcaemia (FHH). CONCLUSIONS This case series illustrates the challenges and successes of managing PHPT in pregnancy. Parathyroidectomy can be safely carried out with excellent outcomes for both mother and child. However, a modified approach to diagnosis and localisation studies is required. We propose a model for investigation and approach to management of such patients.
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Affiliation(s)
- Abigail Walker
- Department of Upper GI and Endocrine Surgery, St Thomas' Hospital, London, UK
| | - Jaime Jimeno Fraile
- Department of Upper GI and Endocrine Surgery, St Thomas' Hospital, London, UK
| | - Johnathan G Hubbard
- Department of Upper GI and Endocrine Surgery, St Thomas' Hospital, London, UK
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Yilmaz BA, Altay M, Değertekin CK, Çimen AR, Iyidir ÖT, Biri A, Yüksel O, Törüner FB, Arslan M. Hyperparathyroid crisis presenting with hyperemesis gravidarum. Arch Gynecol Obstet 2014; 290:811-4. [PMID: 25027815 DOI: 10.1007/s00404-014-3297-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Primary hyperparathyroidism during pregnancy is a rare condition, and the diagnosis may be confounded by pregnancy related conditions. Since the appropriate management reduces the maternal and fetal complications; differential diagnosis becomes quite crucial. METHOD Clinical course of a patient with hyperparathyroid crisis will be discussed with the review of the literature. A 22-year- old, (gravida 2, para 1) woman was presented with hyperparathyroid crisis at the 11th weeks' gestation. She was hospitalized twice due to hyperemesis gravidarum. When she was admitted to the hospital for the third time due to increased vomiting and weight-loss, serum biochemistry panel was performed and it revealed severe hypercalcemia that serum Ca was 17.59 mg/dl, and she was referred to our hospital as parathyroid crisis. Maternal hypercalcemia was resolved after urgent parathyroidectomy. She was diagnosed as preeclampsia at the 30 weeks' gestation and delivered a male infant weighing 1,090 g at 33 weeks' gestation with APGAR scores 6 at 1 min, and 7 at min 5, without evidence of neonatal hypocalcemia or tetany. RESULTS Urgent parathyroidectomy is the definite treatment in symptomatic patients with hyperparathyroidism during pregnancy. Resolving maternal hypercalcemia prevents neonatal tetany and hypocalcemia. CONCLUSION Hyperemesis may lead to hypercalcemic crisis in patients with hyperparathyroidism, so serum Ca level should be checked in patients with hyperemesis gravidarum especially who detoriate rapidly. Although they share some common pathogenetic mechanisms, there is not enough evidence for attributing preeclampsia to primary hyperparathyroidism.
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Affiliation(s)
- Banu Aktaş Yilmaz
- Department of Endocrinology and Metabolism, Gazi University School of Medicine, Ankara, Turkey,
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Diaz-Soto G, Linglart A, Sénat MV, Kamenicky P, Chanson P. Primary hyperparathyroidism in pregnancy. Endocrine 2013; 44:591-7. [PMID: 23670708 DOI: 10.1007/s12020-013-9980-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/06/2013] [Indexed: 12/16/2022]
Abstract
Primary hyperparathyroidism (PHPT) is rarely diagnosed during pregnancy but is associated with significant maternal and fetal morbidity and mortality. Information on appropriate management is limited. We reviewed the medical literature through December 2012 for key articles on PHPT during pregnancy, focusing on large series. Clinical knowledge in this area is restricted to isolated case reports and a few retrospective studies. Diagnosis can be difficult, owing to the non-specific nature of signs and symptoms of hypercalcemia during pregnancy. Pregnant women with a calcium level over 2.85 mmol/L (11.4 mg/dL) and prior pregnancy loss are at a particularly high risk of maternal complications (hypercalcemic crisis, nephrolithiasis, pancreatitis, etc.) and fetal loss. Around one-half of neonates born to mothers with untreated PHPT have hypocalcemia and tetany. Algorithms proposed for the management of the pregnant woman with PHPT are not evidence based, reflecting the paucity of data. Treatment should thus be individually tailored. Gestational age and the severity of hypercalcemia should be taken into account when assessing the risk-benefit balance of a conservative approach (hyperhydration and vitamin D supplementation) versus parathyroid surgery. Current evidence supports parathyroidectomy as the main treatment, performed preferably during the second trimester, when the serum calcium is above 2.75 mmol/L (11 mg/dL). In the patients with mild forms of PHPT, which are nowadays the most frequent, a conservative management is generally preferred.
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Affiliation(s)
- Gonzalo Diaz-Soto
- Service d'Endocrinologie et des Maladies de la Reproduction, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, 94275, Le Kremlin Bicêtre, France
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Bendinelli C, Nebauer S, Quach T, Mcgrath S, Acharya S. Is minimally invasive parathyroid surgery an option for patients with gestational primary hyperparathyroidism? BMC Pregnancy Childbirth 2013; 13:130. [PMID: 23758620 PMCID: PMC3691590 DOI: 10.1186/1471-2393-13-130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/24/2013] [Indexed: 11/15/2022] Open
Abstract
Background Gestational primary hyperparathyroidism is associated with serious maternal and neonatal complications, which require prompt surgical treatment. Minimally invasive parathyroidectomy reduces pain, improves cosmesis and may achieve cure rates comparable to traditional open bilateral neck exploration. We report the clinical course of a woman with newly diagnosed gestational primary hyperparathyroidism and discuss the decision making behind the choice of video-assisted minimally invasive parathyroidectomy, amongst the other minimally invasive parathyroidectomy techniques available. Case presentation A 38-years-old pregnant woman at 9 weeks of gestation, with severe hyperemesis and hypercalcaemia secondary to gestational primary hyperparathyroidism (ionised calcium 1.28 mmol/l) was referred for surgery. Ultrasound examination of her neck identified 2 suspicious parathyroid enlargements. In view of pregnancy, a radioisotope Sestamibi parathyroid scan was not performed. Bilateral four-gland exploration was therefore deemed necessary to guarantee cure. This was performed with video-assisted minimally invasive parathyroidectomy, which relies on a single 15 mm central incision with external retraction and endoscopic magnification, allowing bilateral neck exploration. Surgery was performed at 23 weeks of gestation. Four glands were identified in orthotopic positions of which three had normal appearance. The fourth was a right superior parathyroid adenoma of 756 mg. Ionized calcium (1.12 mmol/l) and PTH (0.9 pmol/l) normalised postoperatively. Patient was discharged on the second postoperative day, needing no pain relief. Cosmetic result was excellent. Her pregnancy progressed normally and she delivered a healthy baby. Conclusion Video-assisted minimally invasive parathyroidectomy allows bilateral four-gland exploration, and is an optimal technique to treat gestational primary hyperparathyroidism. This procedure removes the need for radiation exposure, reduces pain, improves cosmesis and may achieve cure rates comparable to traditional open bilateral neck exploration.
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Abstract
Pregnancy and lactation cause a substantial increase in demand for calcium that is met by different maternal adaptations within each period. Intestinal calcium absorption more than doubles during pregnancy, whereas the maternal skeleton resorbs to provide most of the calcium content of breast milk during lactation. These maternal adaptations also affect the presentation, diagnosis, and management of disorders of calcium and bone metabolism. Although some women may experience fragility fractures as a consequence of pregnancy or lactation, for most women, parity and lactation do not affect the long-term risks of low bone density, osteoporosis, or fracture.
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Primary hyperparathyroidism in pregnancy-a rare cause of life-threatening hypercalcemia: case report and literature review. Case Rep Endocrinol 2011; 2011:520516. [PMID: 22937284 PMCID: PMC3420708 DOI: 10.1155/2011/520516] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 06/26/2011] [Indexed: 11/17/2022] Open
Abstract
Objective. To report a case of primary hyperparathyroidism in a pregnant patient, report the obstetric and neonatal outcomes, and review the relevant literature. Results. A 29-year-old primigravida was successfully treated for PHP with minimally invasive resection of a parathyroid adenoma in the second trimester of pregnancy. A healthy baby girl was delivered at 37-week gestation with an unremarkable neonatal course. To the best of our knowledge, this is the second case report in the literature utilizing intraoperative PTH during a parathyroidectomy in a pregnant woman. Conclusions. Primary hyperparathyroidism is a rare life-threatening condition that can present during pregnancy. The diagnosis can be difficult to establish during pregnancy, given the nonspecific symptoms related to hypercalcemia. However, a better understanding of the condition, improved diagnostic studies, and well-organized multidisciplinary management decisions can significantly reduce the morbidity and mortality associated with the disease during pregnancy.
This case report is presented to highlight the value of early diagnosis and appropriate management of PHP during pregnancy.
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Abstract
Primary hyperparathyroidism is the third most common endocrine disorder after diabetes and thyroid disease, and women are affected twice as often as men. Hyperparathyroidism in pregnancy was first reported in 1931. Maternal complications in patients with hyperparathyroidism can be as high as 67%. We present a case of a pregnant patient with chronic hypertension that was exacerbated throughout the course of her pregnancy with a concomitant diagnosis of primary hyperparathyroidism and its sequelae for both the mother and fetus.
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Affiliation(s)
- Mousumi Som
- Department of Medicine, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
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Krysiak R, Wilk M, Okopien B. Recurrent pancreatitis induced by hyperparathyroidism in pregnancy. Arch Gynecol Obstet 2010; 284:531-4. [PMID: 20848117 PMCID: PMC3155040 DOI: 10.1007/s00404-010-1668-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 08/25/2010] [Indexed: 01/17/2023]
Abstract
Introduction As primary hyperparathyroidism affects mainly middle-aged and elderly women, it is an infrequent finding during gestation and breastfeeding. To date, less than 200 pregnant patients with primary hyperparathyroidism diagnosed during pregnancy have been described. Like in other disorders of the parathyroid gland, the recognition of primary hyperparathyroidism during pregnancy and lactation may be difficult, as clinical symptoms are not specific, while laboratory findings may be masked by some typical pregnancy-induced changes in calcium and phosphate homeostasis. If remains untreated, the disease may result in serious clinical implications for the mother and fetus. Most authors consider surgery within the second trimester of pregnancy as the treatment of choice in this group of patients. Case report In our paper, we discuss the case of a 35-year-old female with a history of recurrent acute pancreatitis and recurrent abortions. As the patient declined surgery, conservative management with calcitonin was started and continued throughout the rest of pregnancy, and led to giving birth to the infant whose only health problem was transient hypocalcemia. Conclusion The described case shows that conservative management, if started respectively early and conducted on the basis of a patient’s condition, may effectively reduce increased perinatal and maternal morbidity and mortality in pregnant women declining surgery.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland.
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Dupuy O, Aubert P, Dumuis ML, Bordier L, Mayaudon H, Bauduceau B. [Hyperparathyroidism during pregnancy: dangerous association for the mother and her infant]. Rev Med Interne 2010; 31:e9-10. [PMID: 20554087 DOI: 10.1016/j.revmed.2010.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 03/11/2010] [Accepted: 04/11/2010] [Indexed: 11/25/2022]
Abstract
Hypercalcaemia during pregnancy is rare but requires a systematic approach for its diagnosis and its treatment. We report a 32-year-old pregnant female at 32 weeks of gestation who presented a severe hypercalcaemia, due to primary hyperparathyroidism. The delivery allowed the birth of a healthy child who had a serum calcium level in the normal range. Eight days later, the mother was operated from a parathyroid adenoma allowing normalisation of calcaemia. Hyperparathyroidism during pregnancy is rarely reported; it can lead to severe complications for both the mother and the infant. The newborn can present tetania due to hypocalcaemia and hypoparathyroidism can be definitive. Surgery should be discussed when serum calcium level of the mother is markedly elevated.
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Affiliation(s)
- O Dupuy
- Service d'endocrinologie et maladies métaboliques, HIA Bégin, Saint-Mandé, France.
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Hui E, Osakwe O, Teoh TG, Tolley N, Robinson S. Three case reports of maternal primary hyperparathyroidism in each trimester and a review of optimal management in pregnancy. Obstet Med 2010; 3:33-7. [PMID: 27582838 DOI: 10.1258/om.2009.090040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2009] [Indexed: 11/18/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) during pregnancy is associated with significant maternal and fetal risks. Prompt diagnosis and effective management during pregnancy can improve both maternal and fetal outcomes. However, there is no consensus with regard to conservative versus surgical management especially in the first and third trimester. We report three cases of PHPT associated with pregnancy that underwent parathyroidectomy each in a different trimester. Cases 1 and 2 were found to have hypercalcaemia and elevated parathyroid hormone levels in the second and first trimesters, respectively. Case 3 was known to have PHPT prenatally but previously declined parathyroidectomy. All three cases underwent parathyroidectomies during pregnancy without significant postoperative complications and all achieved favourable maternal and neonatal outcomes. Maternal hyperparathyroidism represents a preventable cause of maternal morbidity, with fetal morbidity and mortality. The benefits of parathyroidectomy with normalization of serum calcium in the mothers outweigh the risks of hypercalcaemia and suppression of the fetal parathyroid, especially where maternal vitamin D concentration is low.
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Affiliation(s)
| | | | | | - Neil Tolley
- Department of Otolaryngology - Head and Neck Surgery, St Mary's Hospital, Imperial College London , London , UK
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