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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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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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Motlaghzadeh Y, Bilezikian JP, Sellmeyer DE. Hypercalcemia Associated with Pregnancy and Lactation. Endocrinol Metab Clin North Am 2024; 53:437-452. [PMID: 39084818 DOI: 10.1016/j.ecl.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Hypercalcemia during pregnancy is a risk for adverse maternal and fetal consequences. Although primary hyperparathyroidism is by far the most common etiology of hypercalcemia in pregnancy, an array of other etiologies of hypercalcemia associated with pregnancy and lactation have been described. Parathyroidectomy continues to be the preferred treatment for primary hyperparathyroidism. Medical management options are limited.
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Affiliation(s)
- Yasaman Motlaghzadeh
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John P Bilezikian
- Division of Endocrinology, Department of Medicine, Columbia University, New York, USA
| | - Deborah E Sellmeyer
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
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Lim SH, Lim W, Thain SPT. Challenges in the management of hypercalcemia in pregnancy - Case report of two cases. Case Rep Womens Health 2024; 41:e00586. [PMID: 38356696 PMCID: PMC10864752 DOI: 10.1016/j.crwh.2024.e00586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
Hypercalcemia in pregnancy is rare and can pose a great diagnostic challenge due to its asymptomatic presentation. It is associated with maternal complications such as urolithiasis, pancreatitis, renal insufficiency and preeclampsia, fetal complications such as growth restriction and intrauterine fetal demise, and neonatal complications such as neonatal hypocalcemia, tetany and hypoparathyroidism. Prompt diagnosis and treatment of the underlying cause of hypercalcemia is important. Two cases of hypercalcemia in pregnancy were encountered over 12 months. Both presented asymptomatically in the first trimester and were associated with hyperparathyroidism and hypertensive disease in current and previous gestations. Genetic testing ruled out familial hypocalciuric hypercalcemia, and both women required surgical management in the second trimester for control of hypercalcemia. The literature on the diagnosis and management of hypercalcemia in pregnancy is reviewed, and the challenges and pitfalls are discussed. Hypercalcemia in pregnancy requires a high index of suspicion for early diagnosis, and young women with unexplained hypertension in early pregnancy should be investigated for secondary causes, including hypercalcemia and primary hyperparathyroidism. Management of hypercalcemia secondary to primary hyperparathyroidism requires multidisciplinary team management, and surgery should be considered if the patient has not responded to conservative measures, ideally in the second trimester.
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Affiliation(s)
- Shu Hui Lim
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, 299899, Singapore
| | - Weiying Lim
- Department of Endocrinology, Singapore General Hospital, Outram Road, Block 6 Level 6, 169608, Singapore
| | - Serene Pei Ting Thain
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, 299899, Singapore
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Amara IA, Bula-Ibula D. [Diagnosis and management of primary hyperparathyroidism during pregnancy: A systematic review and a longitudinal case study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:531-537. [PMID: 37827286 DOI: 10.1016/j.gofs.2023.10.003] [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: 06/01/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE There is no specific recommendation for management in pregnant women: the aim of this review, based on a clinical case study, is to clarify its development, complications, risk factor and treatment. METHODS A review of the literature was performed by consulting the Pubmed, Cochrane Library, and Science Direct databases. RESULTS Primary hyperparathyroidism is defined as excessive production of parathyroid hormone resulting in hypercalcemia. The prevalence of primary hyperparathyroidism during pregnancy is not known. Indeed, the symptomatology, related to hypercalcemia, is not very specific and easily confused with the clinical manifestations of pregnancy. The physiological changes specific to the pregnant state frequently lead to a slight hypocalcemia which may complicate the diagnosis of primary hyperparathyroidism. Primary hyperparathyroidism results from a parathyroid adenoma in the majority of cases and is detected by ultrasound during pregnancy. Primary hyperparathyroidism in pregnancy causes significant risks to both mother and fetus. The maternal complication rate is 14-67%, however, the most serious complication is hypercalcemic crisis, which requires increased surveillance in the postpartum period. Obstetrical complications are also induced by primary hyperparathyroidism, such as acute polyhydramnios, or intrauterine growth retardation. The fetal complication rate can reach 45-80% of cases with neonatal hypocalcemia as the main complication. If medical treatment is based on hyperhydration, only surgical treatment is curative. CONCLUSION Surgery should be proposed to symptomatic patients or those with high blood calcium levels, discussed in interdisciplinary committee and should be organized ideally in the second trimester to avoid maternal and fetal complications.
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Affiliation(s)
- Inesse Ait Amara
- CHU de Brugmann, place A.-Van-Gehuchten 4, 1020 Bruxelles, Belgique.
| | - Diana Bula-Ibula
- CHU de Brugmann, place A.-Van-Gehuchten 4, 1020 Bruxelles, Belgique
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Zhong H, Liao Q, Liu J. Expert consensus on multidisciplinary approach to the diagnosis and treatment of primary hyperparathyroidism in pregnancy in China. Endocrine 2023; 82:282-295. [PMID: 37221429 DOI: 10.1007/s12020-023-03392-w] [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: 03/15/2023] [Accepted: 04/29/2023] [Indexed: 05/25/2023]
Abstract
Primary hyperparathyroidism in pregnancy is a rare disease that can have detrimental effects on both maternal and fetal/neonatal outcomes. The physiological changes that occur during pregnancy can complicate the diagnosis, imaging examinations, and treatment of this disorder. To enhance our understanding and management of primary hyperparathyroidism in pregnancy, experts from various fields, including endocrinology, obstetrics, surgery, ultrasonography, nuclear medicine, pediatrics, nephrology, and general practice in China, collaborated to develop a consensus addressing the critical aspects of the diagnosis and treatment of primary hyperparathyroidism in pregnancy with a multidisciplinary team approach. This consensus provides valuable guidance for healthcare professionals in managing this condition, ultimately improving outcomes for both mothers and their babies.
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Affiliation(s)
- Huiping Zhong
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, 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.
| | - Jianmin Liu
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Arshad MF, Arambewela MH, Bennet WM, Sterrenburg M, Balasubramanian SP. Primary hyperparathyroidism in pregnancy: experience of a tertiary centre. Surg Today 2022; 53:470-475. [PMID: 36107253 PMCID: PMC10042935 DOI: 10.1007/s00595-022-02583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 08/03/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Background and purpose
The management of primary hyperparathyroidism (PHPT) during pregnancy is challenging and there is no clear consensus on whether it increases the risk of complications in pregnancy. We conducted this study to review the maternal and fetal outcomes of pregnant women treated for PHPT in a single centre.
Methods
Data on relevant clinical parameters, demographics, management strategies, maternal and fetal outcomes were collected from the medical records of pregnant patients with PHPT diagnosed between 2012 and 2019.
Results
Of 15 pregnant women with PHPT, 6 were managed medically and 9 underwent surgery. The median age at their index pregnancy was 28 years [range 19–42]. The median highest adjusted calcium level in the medical group was 2.90 [range 2.61–3.25] mmol/L vs. 3.11 [2.78–4.95] mmol/L in the surgical group. There was one miscarriage and the stillbirth of twins in the medical group, but no such outcomes in the surgical group. The median gestational ages were 39 + 3 weeks [range 24 + 2–41 + 2 weeks] and 39 + 4 weeks [range 37 + 1–39 + 5 weeks] in the medical and surgical groups, respectively. No birth was complicated by neonatal tetany or convulsions.
Conclusion
More complications developed in the pregnant PHPT patients who were managed medically than in those who underwent surgery. Surgery performed during the second trimester resulted in good outcomes. Multi-centre prospective studies are required to ascertain the risk of various complications in women with PHPT during pregnancy.
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Affiliation(s)
- Muhammad Fahad Arshad
- Oncology and Metabolism, University of Sheffield Medical School, Sheffield, S10 2RX, UK.
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK.
| | - Maulee Hiromi Arambewela
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
- University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - William M Bennet
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Monique Sterrenburg
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Saba P Balasubramanian
- Oncology and Metabolism, University of Sheffield Medical School, Sheffield, S10 2RX, UK
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
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8
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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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10
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Abstract
Hypercalcemic disorders are rare in pregnant women and are usually due to primary hyperparathyroidism. Clinical manifestations of hypercalcemia are nonspecific and can be masked by the physiologic changes of pregnancy. Furthermore, routine antenatal screening does not include serum calcium measurement and a hypercalcemia diagnosis may therefore be delayed until term or even after delivery. Timely recognition and appropriate interventions are essential to decrease maternal and fetal complications. Conservative measures are appropriate in the presence of mild hypercalcemia. Parathyroidectomy remains the mainstay of treatment for primary hyperparathyroidism with significant hypercalcemia not responding to conservative measures.
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Affiliation(s)
- Karel Dandurand
- Division of Endocrinology and Metabolism, McMaster University, Bone Research and Education Centre, 3075 Hospital Gate, Unit 223, Oakville, ON L6M 1M1, Canada
| | - Dalal S Ali
- Division of Endocrinology and Metabolism, McMaster University, Bone Research and Education Centre, 3075 Hospital Gate, Unit 223, Oakville, ON L6M 1M1, Canada
| | - Aliya A Khan
- Division of Endocrinology and Metabolism, McMaster University, Bone Research and Education Centre, 3075 Hospital Gate, Unit 223, Oakville, ON L6M 1M1, Canada.
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11
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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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12
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Zhang L, Luo YR, Hu Y, Zhai Y, Gao H, Cao Z. Primary Hyperparathyroidism in Pregnancy: Insights From a Case of a 28-Year-Old Woman With Miscarriages and Hyperemesis Gravidarum. Ann Lab Med 2021; 41:336-338. [PMID: 33303721 PMCID: PMC7748091 DOI: 10.3343/alm.2021.41.3.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/02/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lin Zhang
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yiqi Ruben Luo
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Yanjin Hu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yanhong Zhai
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hong Gao
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zheng Cao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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Pal R, Bhadada SK, Gupta N, Behera A, Aggarwal N, Aggarwal A, Raviteja KV, Saikia UN, Kaur G, Arvindbhai SM, Walia R. Primary hyperparathyroidism in pregnancy: observations from the Indian PHPT registry. J Endocrinol Invest 2021; 44:1425-1435. [PMID: 33037580 DOI: 10.1007/s40618-020-01441-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/29/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE To present the data on primary hyperparathyroidism (PHPT) in pregnancy from India obtained from a large database maintained over 15 years. METHODS We retrieved data of all women with gestational PHPT from the Indian PHPT registry between July 2005 and January 2020, and compared their clinical, biochemical, and other characteristics with age-matched non-pregnant women with PHPT. RESULTS Out of 386 women, eight had gestational PHPT (2.1%). The common presenting manifestations were acute pancreatitis (50%) and renal stone disease (50%); two were asymptomatic. Five women (62.5%) had a history of prior miscarriages. Seven patients (88%) had preeclampsia during the present gestation. Serum calcium and intact parathyroid hormone (iPTH) were not statistically different from the age-matched non-pregnant PHPT group. Six patients with mild-to-moderate hypercalcemia were medically managed with hydration with/without cinacalcet while one patient underwent percutaneous ethanol ablation of the parathyroid adenoma; none underwent surgery during pregnancy. Mean serum calcium maintained from treatment initiation till delivery was 10.5 ± 0.4 mg/dl. One patient had spontaneous preterm delivery at 36 weeks; the remaining patients had normal vaginal delivery at term. None had severe preeclampsia/eclampsia. Fetal outcomes included low birth weight in three newborns (37.5%); two of them had hypocalcemic seizures. CONCLUSION The prevalence of gestational PHPT was 2.1% in this largest Indian PHPT cohort, which is higher than that reported from the West (< 1%). Gestational PHPT can lead to preeclampsia and miscarriage. Pregnant PHPT patients with mild-to-moderate hypercalcemia can be managed with hydration/cinacalcet; however, long-term safety data and large-scale randomized controlled trials are required.
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Affiliation(s)
- R Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - S K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - N Gupta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - A Behera
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - N Aggarwal
- Department of Gynecology and Obstetrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - A Aggarwal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - K V Raviteja
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - U N Saikia
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - G Kaur
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - S M Arvindbhai
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - R Walia
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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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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15
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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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16
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Perelli S, Calogero AE, Condorelli RA, Cannarella R, Garofalo A, Brescia R, Ciuni R, Greco EA, LA Vignera S. Conservative management of primary hyperparathyroidism in pregnancy. Minerva Endocrinol (Torino) 2021; 46:484-486. [PMID: 33855389 DOI: 10.23736/s2724-6507.21.03475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah Perelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Angela Garofalo
- Department of Gynecology and Obstetrics, Policlinico G. Rodolico of Catania, Catania, Italy
| | - Roberta Brescia
- Department of Gynecology and Obstetrics, Policlinico G. Rodolico of Catania, Catania, Italy
| | - Roberto Ciuni
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Emanuela A Greco
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Sandro LA Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy -
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17
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Sandler ML, Ho R, Xing MH, Gidumal S, Spitzer H, Levy JC, Chai RL. Primary Hyperparathyroidism During Pregnancy Treated With Parathyroidectomy: A Systematic Review. Laryngoscope 2021; 131:1915-1921. [PMID: 33751589 DOI: 10.1002/lary.29489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES/HYPOTHESIS The primary objective of this study was to assess the safety of parathyroidectomy during pregnancy as treatment for hyperparathyroidism (HPTH) in comparison to nonsurgical management plans. Secondary outcomes involved analyzing the safety of surgery in the third trimester and the benefit of operating on asymptomatic pregnant patients. STUDY DESIGN Systematic review. METHODS PRISMA-guided systematic review of all cases of primary hyperparathyroidism during pregnancy published in peer-reviewed English journals on PubMed/MEDLINE, EMBASE, and SCOPUS from 1980 to 2020. RESULTS A total of 75 manuscripts were included in this review describing 382 cases of gestational hyperparathyroidism. The median maternal age was 31 years. Overall, 108 cases (28.3%) underwent parathyroidectomy during pregnancy while 274 cases (71.7%) were treated nonsurgically. The majority of surgeries took place during the second trimester (67.6%). Complications and/or deaths were less likely to occur after surgery in the second trimester (4.48%) as compared to surgery in the third trimester (21.1%). Nine surgically treated cases resulted in infant complications and/or death; however, none of these nine cases had any surgical complications. Despite these complications, the overall infant complication rate for patients who underwent surgical treatment remained lower than that of patients treated with conservative therapy (9.1% vs. 38.9%). CONCLUSIONS This review suggests that for all pregnant patients with diagnosed HPTH, parathyroidectomy should be considered regardless of symptomatology. Our data suggest that parathyroidectomy is associated with fewer risks than more conservative treatments and results in better fetal outcomes. Surgery during the third trimester is feasible and surgery should be considered in both symptomatic and asymptomatic patients. Laryngoscope, 131:1915-1921, 2021.
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Affiliation(s)
- Mykayla L Sandler
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Rebecca Ho
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Monica H Xing
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Sunder Gidumal
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Spitzer
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Juliana C Levy
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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18
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Dias Leite S, Ormonde CC, Ormonde MC, Raposo JTBV, Sampaio JIN, Melo BCDS. Preeclampsia as an Inaugural Manifestation of Primary Hyperparathyroidism: A Case Report. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:841-844. [PMID: 33348402 PMCID: PMC10309195 DOI: 10.1055/s-0040-1718447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Primary hyperparathyroidism is an endocrine disorder characterized by hypercalcemia and elevated or inappropriately normal levels of parathyroid hormone. The diagnosis is based on a biochemical evaluation, and a neck ultrasound is the first choice during pregnancy to access the parathyroid glands. Manifestations during pregnancy are rare and can be present with life-threatening complications, so the diagnosis is challenging. The conservative treatment is limited, and there is not enough data about its safety and efficacy during pregnancy. Surgery is the only curative treatment, and a parathyroidectomy performed during the second or third trimesters is considered safe. Recently, some authors suggested an association between primary hyperparathyroidism and preeclampsia. We describe a case of preeclampsia with severe features at 27 weeks of gestational age. The severity of the preeclampsia motivated an early termination of the pregnancy by cesarean section. During the postpartum period, the patient presented life-threatening complications, such as severe hypercalcemia and acute pancreatitis. An ultrasound exam found two parathyroid nodules, suggestive of parathyroid adenomas. The patient recovered after the pharmacological correction of the calcemia levels.
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19
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Li Q, Xu XZ, Shi JH. Synchronous parathyroid adenoma, papillary thyroid carcinoma and thyroid adenoma in pregnancy: A case report. World J Clin Cases 2020; 8:5426-5431. [PMID: 33269280 PMCID: PMC7674750 DOI: 10.12998/wjcc.v8.i21.5426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer, but this relationship is infrequent in pregnant patients with primary hyperparathyroidism (PHPT).
CASE SUMMARY A 27-year-old gravida 1 woman was transferred to our hospital at 16 wk of pregnancy. She was diagnosed with parathyroidoma, papillary carcinoma of the thyroid and thyroid adenoma and was managed surgically. Both the mother and the newborn were stable after a right inferior parathyroidectomy and total thyroidectomy. The healthy infant was delivered at the 40th week of pregnancy. The mother had no evidence of recurrence over three years of follow-up.
CONCLUSION Awareness of concomitant PHPT and thyroid diseases may help in managing patients with a history of hypercalcemia.
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Affiliation(s)
- Qiang Li
- Department of Breast and Thyroid Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu Province, China
| | - Xiao-Zhang Xu
- Department of Breast and Thyroid Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu Province, China
| | - Jian-Hua Shi
- Department of Breast and Thyroid Surgery, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huai'an 223300, Jiangsu Province, China
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20
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Latif A, Gastelum AA, Farhan K, Jagadesh S, Mutnuri S. Treatment approach for primary hyperparathyroidism in pregnancy. Proc (Bayl Univ Med Cent) 2020; 34:191-193. [PMID: 33456198 DOI: 10.1080/08998280.2020.1834791] [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] [Indexed: 12/30/2022] Open
Abstract
Primary hyperparathyroidism is rare in pregnancy, with an incidence of 1%. It is associated with maternal, fetal, and neonatal complications. Herein, we present two patients with gestational primary hyperparathyroidism who failed medical management and underwent successful parathyroidectomy. Based on our experience and review of the literature, gestational hyperparathyroidism appears to be a clear indication for early parathyroidectomy in both symptomatic and asymptomatic patients.
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Affiliation(s)
- Azka Latif
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Alheli Arce Gastelum
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Kinaan Farhan
- Jinnah Medical and Dental College, Karachi, Pakistan
| | - Sunil Jagadesh
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska.,Medical School, Department of Nephrology, Creighton University School of Medicine, Omaha, Nebraska
| | - Sangeeta Mutnuri
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska.,Medical School, Department of Nephrology, Creighton University School of Medicine, Omaha, Nebraska
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21
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Cassir G, Sermer C, Malinowski AK. Impact of Perinatal Primary Hyperparathyroidism on Maternal and Fetal and Neonatal Outcomes: Retrospective Case Series. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:750-756. [PMID: 32238314 DOI: 10.1016/j.jogc.2019.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to describe the maternal, fetal, and neonatal outcomes of primary hyperparathyroidism in a contemporary setting through a retrospective case series conducted in a tertiary referral centre focused on women diagnosed with primary hyperparathyroidism prior to conception, in the antepartum period, or within 6 weeks postpartum. METHODS A retrospective chart review was conducted and data were abstracted to case report forms. Summary statistics are reported. RESULTS From 2000 to 2017, 19 women (23 pregnancies) with primary hyperparathyroidism were identified. Most women (79%) were symptomatic at presentation, though often with non-specific manifestations. While 14% of pregnancies involved maternal/obstetric complications, fetal/neonatal complications were observed in 45%. Mild hypercalcemia was identified in 57% of women, with accompanying hypophosphatemia and hypomagnesemia in 46% and 36% of women, respectively. Surgical intervention was performed for 89% women, and no complications were encountered. Normal calcium levels achieved through treatment before conception did not fully eliminate adverse outcomes. CONCLUSION Rates of perinatal complications in our series are more reassuring than the ubiquitously quoted rates from small and dated studies. The diagnosis of primary hyperparathyroidism may be easily missed during pregnancy, owing to its non-specific presentation. A high index of suspicion and measurement of ionized calcium levels is encouraged, especially for patients with excessive nausea and vomiting, nephrolithiasis, atypical presentations of hypertensive disorders, or isolated polyhydramnios. Mild degrees of calcium derangement do not preclude adverse perinatal outcomes. Surgery appears to be safe, even in the third trimester. The attenuated rate of complications noted in our series may have been the result of the high proportion of surgery, though this will require verification via meta-analysis or future prospective work.
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Affiliation(s)
- Gabrielle Cassir
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON; Department of Medicine, University of Toronto, Toronto, ON.
| | - Corey Sermer
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON; Department of Medicine, University of Toronto, Toronto, ON
| | - Ann Kinga Malinowski
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON; Department of Medicine, University of Toronto, Toronto, ON; Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON
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22
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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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23
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Rigg J, Gilbertson E, Barrett HL, Britten FL, Lust K. Primary Hyperparathyroidism in Pregnancy: Maternofetal Outcomes at a Quaternary Referral Obstetric Hospital, 2000 Through 2015. J Clin Endocrinol Metab 2019; 104:721-729. [PMID: 30247615 DOI: 10.1210/jc.2018-01104] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/17/2018] [Indexed: 12/14/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) in pregnancy has historically been associated with substantial maternofetal morbidity and mortality rates. The optimal treatment and timing of surgical intervention in pregnancy remain contested. OBJECTIVE To compare maternofetal outcomes of medically and surgically treated patients with PHPT in pregnancy. DESIGN Retrospective chart review. SETTING Quaternary referral hospital. PATIENTS Women with PHPT in pregnancy treated between 1 January 2000 and 31 December 2015. INTERVENTIONS Medical therapy or parathyroid surgery. MAIN OUTCOMES MEASURED Timing of diagnosis; maternal corrected serum calcium concentrations; gestation, indication and mode of delivery; complications attributable to PHPT; birth weight; and admission to the neonatal intensive care unit (NICU). RESULTS Twenty-two pregnancies were managed medically, and six patients underwent parathyroidectomy in pregnancy (five in trimester 2, and one at 32 weeks gestation). Most patients treated medically either had a corrected serum calcium concentration <2.85 mmol/L in early pregnancy or had PHPT diagnosed in trimester 3. Of viable medically managed pregnancies, 30% were complicated by preeclampsia, and preterm delivery occurred in 66% of this group. All preterm neonates required admission to the NICU for complications related to prematurity. All surgically treated patients delivered their babies at term, and there were no complications of parathyroid surgery. CONCLUSION Maternofetal outcomes have improved relative to that reported in early medical literature in patients treated medically and surgically, but the rates of preeclampsia and preterm delivery were higher in medically treated patients. The study was limited by its retrospective design and small sample sizes.
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MESH Headings
- Adult
- Antihypertensive Agents/therapeutic use
- Calcium/blood
- Female
- Humans
- Hyperparathyroidism, Primary/blood
- Hyperparathyroidism, Primary/complications
- Hyperparathyroidism, Primary/therapy
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/therapy
- Infusions, Intravenous
- Intensive Care Units, Neonatal/statistics & numerical data
- Pamidronate/therapeutic use
- Parathyroidectomy/statistics & numerical data
- Pre-Eclampsia/epidemiology
- Pre-Eclampsia/etiology
- Pregnancy
- Premature Birth/epidemiology
- Premature Birth/etiology
- Referral and Consultation/statistics & numerical data
- Rehydration Solutions/administration & dosage
- Retrospective Studies
- Time Factors
- Young Adult
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Affiliation(s)
- Jane Rigg
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
| | - Elise Gilbertson
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- The University of Queensland, Sunshine Coast Clinical Unit, Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - Helen L Barrett
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
| | - Fiona L Britten
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
| | - Karin Lust
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- The University of Queensland, Royal Brisbane Clinical Unit, Herston, Queensland, Australia
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24
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DiMarco AN, Meeran K, Christakis I, Sodhi V, Nelson-Piercy C, Tolley NS, Palazzo FF. Seventeen Cases of Primary Hyperparathyroidism in Pregnancy: A Call for Management Guidelines. J Endocr Soc 2019; 3:1009-1021. [PMID: 31065618 PMCID: PMC6497920 DOI: 10.1210/js.2018-00340] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/11/2019] [Indexed: 12/17/2022] Open
Abstract
Context The risks of primary hyperparathyroidism (pHPT) to pregnant women and their fetuses appear to increase commensurate with serum calcium levels. The management strategy for pHPT must be adapted in pregnancy and should reflect the severity of hypercalcemia. However, no guidelines exist to assist clinicians. Methods The experience of a high-volume multidisciplinary endocrine surgical service in treating a consecutive series of pregnant women with pHPT referred for parathyroidectomy is presented and data are compared with a nonpregnant cohort with pHPT. A review of pHPT and pregnancy outcomes in the literature is provided. Results Seventeen pregnant women and 247 age range-matched nonpregnant women with pHPT were referred for surgery over 11 years. Mean serum calcium level was higher in the pregnant cohort (2.89 vs 2.78 mmol/L; P = 0.03). Preoperative localization with ultrasound succeeded in eight pregnant women (47%) and sestamibi scanning did in two of six (33% imaged preconception), compared with 84 (34%) and 102 (42%) control subjects, respectively (not significant). Parathyroidectomy was performed under general anesthesia between 12 and 28 weeks' gestation with no adverse pregnancy outcomes resulting. Cure rate was 100% vs 96% in controls. Conclusion pHPT in pregnancy is a threat to mother and child. Medical management may be appropriate in mild disease, but in moderate to severe disease, parathyroidectomy under general anesthesia in the second trimester is safe. Localization using ionizing radiation/MRI is unnecessary, because surgical intervention in a high-volume multidisciplinary setting has excellent outcomes. Guidelines on the topic would assist clinicians.
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Affiliation(s)
- Aimee Natasha DiMarco
- Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Endocrine Surgery, Hammersmith Hospital, London, United Kingdom
| | - Karim Meeran
- Department of Medicine, Imperial College, London, United Kingdom.,Department of Endocrinology, Imperial College National Health Service Trust, London, United Kingdom
| | - Ioannis Christakis
- Department of Endocrine and General Surgery, Kings' College Hospital, London, United Kingdom
| | - Vinpreet Sodhi
- Department of Anaesthesia, Imperial College National Health Service Trust, London, United Kingdom
| | - Catherine Nelson-Piercy
- Department of Obstetric Medicine, Guy's and St. Thomas' Foundation Trust, London, United Kingdom.,Department of Obstetric Medicine, Imperial College National Health Service Trust, London, United Kingdom
| | - Neil Samuel Tolley
- Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Endocrine Surgery, Hammersmith Hospital, London, United Kingdom
| | - Francesco Fausto Palazzo
- Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Endocrine Surgery, Hammersmith Hospital, London, United Kingdom
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25
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Nilsson IL. Primary hyperparathyroidism: should surgery be performed on all patients? Current evidence and residual uncertainties. J Intern Med 2019; 285:149-164. [PMID: 30289185 DOI: 10.1111/joim.12840] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Primary hyperparathyroidism (pHPT) is the third most common endocrine disease and is characterized by hypercalcaemia and elevated or inappropriately 'normal' levels of the parathyroid hormone (PTH). The main target organs of PTH are the skeletal system and the kidneys. Before the 1970s, pHPT was a rarely detected disease associated with notable morbidity and premature mortality. Introduction of biochemical screening, allowing for a wide range of indications, has contributed to the detection of the full spectrum of the disease. A new entity with an isolated elevation of PTH, normocalcaemic HP, has emerged and is currently being explored. The highest incidence of pHPT, 3-5%, is observed amongst women, and the prevalence increases with age. The female-to-male ratio is 3-4 : 1 except in younger patients where distribution is equal and known hereditary causes account for approximately 10% of the cases. In the last few decades, it has become evident that fewer patients than previously believed are truly asymptomatic. The cause of pHPT is often a benign tumour, a parathyroid adenoma, and the only definite treatment is parathyroidectomy (PTX). No medical treatment, single or combined, can achieve a curing of pHPT. Recent data indicate that PTX, despite being proven to be cost-effective compared to conservative treatment, is underutilized, especially in elderly pHPT patients. The decision of PTX should always be based on a safe diagnosis, and the potential benefits of curative treatment should not be outweighed by the risks of surgery or anaesthesia.
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Affiliation(s)
- I-L Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department ofBreast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
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26
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Mokrysheva NG, Eremkina AK, Mirnaya SS, Rozhinskaya LY, Kuznetsov NS, Yesayan RM, Kan NE, Dudinskaya EN. A Case of Pregnancy Complicated by Primary Hyperparathyroidism Due to a Parathyroid Adenoma. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:53-59. [PMID: 30636767 PMCID: PMC6340266 DOI: 10.12659/ajcr.912436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Primary hyperparathyroidism is most common in women during the menopause and its occurrence in pregnant women is rare. However, because neonatal mortality is associated with maternal hyperparathyroidism, early diagnosis is essential. This report describes the case of a late diagnosis of primary hyperparathyroidism in a 28-year-old pregnant woman and describes the effects on the mother and neonate. CASE REPORT During her second pregnancy, a 28-year-old woman presented with symptoms of general weakness, bone and joint pain, multiple fractures with bone deformity, muscle weakness, and gait disturbance. Due to the high risk of perinatal pathology, a cesarean section was performed. Several weeks later, she underwent thoracoscopic removal of an ectopic parathyroid gland located at the aortic arch. Hypocalcemia in the newborn infant required treatment with calcium and magnesium supplements. CONCLUSIONS This case demonstrates that primary hyperparathyroidism during pregnancy requires timely diagnosis and treatment to reduce potential maternal and fetal complications. Screening for primary hyperparathyroidism should be undertaken in pregnant women with any symptoms associated with hypercalcemia. Treatment should be individualized and includes conservative management, parathyroidectomy in the second trimester, or parathyroidectomy performed in the early postpartum period.
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Affiliation(s)
- Natalia G Mokrysheva
- Department of Parathyroid Gland Pathology, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Anna K Eremkina
- Department of Parathyroid Gland Pathology, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Svetlana S Mirnaya
- Department of Parathyroid Gland Pathology, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Lyudmila Y Rozhinskaya
- Department of Neuroendocrinology and Bone Disease, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Nikolay S Kuznetsov
- Department of Surgery, Endocrinology Research Center, The Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
| | - Rosa M Yesayan
- Department of Therapy, The National Medical Research Center for Obstetrics, Gynecology and Perinatology (named after V.I. Kulakov), Moscow, Russian Federation
| | - Natalia E Kan
- Department of Obstetrics, The National Medical Research Center for Obstetrics, Gynecology and Perinatology (named after V.I. Kulakov), Moscow, Russian Federation
| | - Ekaterina N Dudinskaya
- Laboratory of Age-Related Metabolic and Endocrine Disorders, The Russian Gerontology Clinical Research Center, Moscow, Russian Federation
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Preterm Parturient with Polyhydramnios and Pancreatitis: Primary Presentation of Hyperparathyroidism. Case Rep Obstet Gynecol 2018; 2018:2091082. [PMID: 29607233 PMCID: PMC5828412 DOI: 10.1155/2018/2091082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/21/2017] [Indexed: 11/17/2022] Open
Abstract
Objective To report a case of severe hypercalcemia secondary to primary hyperparathyroidism in a late-preterm pregnant patient and review medical and surgical treatments as well as obstetric and neonatal outcomes. Background Diagnosis of parathyroid disease during pregnancy can be difficult due to nonspecific presentation. Management decisions are complex and require multidisciplinary collaboration. Case A 29-year-old G2P1001 woman at 35 weeks and 3 days' gestation presented with preterm contractions, polyhydramnios, pancreatitis, and severe hypercalcemia. Work-up revealed primary hyperparathyroidism with multiple thyroid nodules. Patient history, presentation, and biopsy were suspicious for parathyroid carcinoma. Despite severe hypercalcemia, both patient and fetus remained stable and medical management was pursued in an attempt to optimize mother and fetus prior to delivery. Due to recalcitrant hypercalcemia, surgical resection was ultimately required. She was subsequently delivered in the setting of preterm labor. Final pathology revealed parathyroid adenoma with atypia and occult papillary thyroid carcinoma. Conclusion Symptoms of hypercalcemia can mimic those of a normal third trimester pregnancy and can have serious maternal and fetal effects if left untreated. A coordinated, multidisciplinary approach to these patients is necessary.
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Sharma R, Bhanupriya, Bhartiya V, Guleria K, Suneja A. Hyperparathyroidism during Pregnancy- A Diagnostic and Therapeutic Challenge. J Clin Diagn Res 2017; 11:QD05-QD07. [PMID: 29207788 DOI: 10.7860/jcdr/2017/25948.10688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
Abstract
Primary Hyperparathyroidism (PHP) is a rare event in pregnancy; Maternal complications in PHP patients can be as high as 67%. It can be overlooked easily because of many similar complaints shared by hyperparathyroidism and pregnancy such as nausea and vomiting, gastritis, bone aches, easy fatigability. Hypercalcemic crisis can develop resulting in coma and death. Neonatal effects are tetany and death in about 80% of cases. We report a case, of an antenatal woman at 30 weeks gestation with complains of painful swelling in left lower jaw and below right knee, pain over right hip joint and frequent episodes of gastritis. She was finally diagnosed to have primary hyperparathyroidism and brown tumour due to parathyroid adenoma. The baby was kept in Neonatal Intensive Care Unit (NICU) for three weeks, in view of prematurity with respiratory distress and later developed sepsis with DIC. The patient's signs and symptoms regressed after parathyroid surgery and the baby was healthy at the time of discharge. This case highlights the progressive deterioration of the patient because of lack of awareness of this disease process and its impact on maternal and foetal morbidity.
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Affiliation(s)
- Richa Sharma
- Assistant Professor, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi, India
| | - Bhanupriya
- Assistant Professor, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi, India
| | - Vishnu Bhartiya
- Assistant Professor, Department of Obstetricsand Gynaecology, UCMS and GTB Hospital, Delhi, India
| | - Kiran Guleria
- Director Professor, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi, India
| | - Amita Suneja
- Director Professor and Head, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital, Delhi, India
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Medza A, Obolonczyk L, Lewalska A, Buss T, Peksa R, Siekierska-Hellmann M, Berendt-Obolonczyk M, Wisniewski P, Sworczak K. Self-diagnosis of hyperparathyroidism during pregnancy resulting in parathyroidectomy and uncomplicated delivery. Gynecol Endocrinol 2017; 33:425-428. [PMID: 28277104 DOI: 10.1080/09513590.2017.1296946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Primary hyperparathyroidism is a condition with hypercalcemia and elevated parathyroid hormone (PTH). Typically, treating patients with such disease does not pose a problem for doctors, unless the patient is pregnant. Firstly, pregnancy may mask signs of hypercalcemia. Secondly, treatment should be applied with special care for immature fetus. If undiagnosed and untreated, it is life-threatening for the mother and the baby. The main cause of primary hyperparathyroidism is parathyroid adenoma, which should be removed surgically in second trimester. If the patient is monitored by a multidisciplinary team, the risk of mortality and pregnancy loss is reduced.
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Affiliation(s)
| | | | | | | | - Rafal Peksa
- c Department of Pathology , Medical University of Gdansk , Gdansk , Poland
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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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Gokkaya N, Gungor A, Bilen A, Bilen H, Gviniashvili D, Karadeniz Y. Primary hyperparathyroidism in pregnancy: a case series and literature review. Gynecol Endocrinol 2016; 32:783-786. [PMID: 27243597 DOI: 10.1080/09513590.2016.1188916] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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
Primary Hyperparathyroidism (PHP) in pregnancy constitutes a serious danger to mother and fetus. The diagnosis of PHP in pregnancy presents a challenge, and PHP commonly goes unidentified and untreated in pregnancy. We present four case reports about patients having PHP, which is very rare condition in pregnancy and their treatment modalities. Three patients, not to be controlled biochemically, denied the parathyroidectomy operation although they are informed about the details of their disease. They are followed up with medical therapy. The first one had no maternal or fetal complications, the second one acquired nephrolithiasis crisis in the last trimester and the third one gave birth to a premature baby who succumbed to tetany. The fourth patient who underwent parathyroidectomy operation in the second trimester had no maternal or fetal complications. PHP in pregnancy is a preventable cause of fetal and maternal mortality and morbidity. Thus, suspecting from PHP during the pregnancy and early diagnosis is critically important in terms of maternal and fetal wellness.
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Affiliation(s)
- Naile Gokkaya
- a Department of Internal Medicine , Division of Endocrinology and Metabolism, Faculty of Medicine , Central Campus , University of Ataturk , Erzurum , Turkey
| | - Adem Gungor
- b Department of Internal Medicine , Division of Endocrinology and Metabolism, Faculty of Medicine, University of Ataturk , Erzurum , Turkey , and
| | - Arzu Bilen
- c Department of Internal Medicine , Faculty of Medicine, University of Ataturk , Erzurum , Turkey
| | - Habib Bilen
- b Department of Internal Medicine , Division of Endocrinology and Metabolism, Faculty of Medicine, University of Ataturk , Erzurum , Turkey , and
| | - Darina Gviniashvili
- b Department of Internal Medicine , Division of Endocrinology and Metabolism, Faculty of Medicine, University of Ataturk , Erzurum , Turkey , and
| | - Yusuf Karadeniz
- b Department of Internal Medicine , Division of Endocrinology and Metabolism, Faculty of Medicine, University of Ataturk , Erzurum , Turkey , and
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Preeclampsia: A Possible Complication of Primary Hyperparathyroidism. Case Rep Obstet Gynecol 2016; 2016:7501263. [PMID: 27340578 PMCID: PMC4909923 DOI: 10.1155/2016/7501263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 12/26/2022] Open
Abstract
Background. Primary hyperparathyroidism is rare in pregnancy. An association between primary hyperparathyroidism and preeclampsia has been reported in few cases worldwide. Case. A 28-year-old woman (gravida 2, para 0, and abortus 1) in her 27th week of gestation was hospitalized due to a high reading of blood pressure (194/115 mmHg) that was not accompanied by any symptoms or signs of preeclampsia. Incidentally, she was found to have a high adjusted calcium and serum parathyroid hormone (PTH) level during admission. Ultrasonographic examination of the neck revealed the presence of parathyroid adenoma. She was scheduled for surgical excision after receiving an intravenous hydration. Fetal ultrasonography revealed a growth restricted fetus with normal biophysical profile. On the sixth day of hospitalization, the patient complained of headache and epigastric pain, with elevated BP and proteinuria. The fetal nonstress test was "nonreassuring." Subsequently, she had an emergency cesarean delivery and surgical removal of the adenoma. The mother and her newborn were then transferred to intensive care, where their clinical course was unremarkable. The mother was discharged after 3 days, while the neonate stayed for close observation for 60 days. Conclusion. Early recognition of primary hyperparathyroidism among women with preeclampsia is important to prevent maternal and fetal morbidity and mortality.
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Stringer KM, Gough J, Gough IR. Primary hyperparathyroidism during pregnancy: management by minimally invasive surgery based on ultrasound localization. ANZ J Surg 2015; 87:E134-E137. [PMID: 26631158 DOI: 10.1111/ans.13378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary hyperparathyroidism in pregnancy has the potential to seriously impact the mother and foetus. Management may be difficult because the condition is usually diagnosed during pregnancy necessitating a rapid decision to proceed with surgery. Minimally invasive surgery is appealing due to shorter operative times and lower risk of complications. METHOD We present a consecutive series of eight women diagnosed with hyperparathyroidism during pregnancy. RESULTS All eight women were treated successfully by parathyroidectomy during pregnancy with no maternal or foetal complications. Seven of these 8 women were treated with minimally invasive parathyroidectomy based on ultrasound localization. CONCLUSION Where ultrasound localization is performed by experienced endocrine surgeons, minimally invasive parathyroidectomy is a feasible and safe approach in the pregnant patient with primary hyperparathyroidism.
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Affiliation(s)
| | - Jenny Gough
- Wesley Medical Centre, Brisbane, Queensland, Australia
| | - Ian R Gough
- Wesley Medical Centre, Brisbane, Queensland, Australia
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Abstract
OBJECTIVE To study pregnancy and pregnancy outcomes in women with primary hyperparathyroidism (PHPT) and in controls. DESIGN Register-based retrospective cohort study of women aged 16-44 years with a diagnosis of PHPT with age- and gender-matched non-exposed controls in Denmark. METHODS The patients and controls were identified using the Danish National Hospital Discharge Register for the period 1977-2010. The outcomes were determined using the Birth Register, the Abortion Register and the LPR (National Hospital Discharge Register). The primary outcome was the relative risk of abortions in patients compared with controls. RESULTS A total of 1057 women with PHPT and 3171 controls were identified. The number of women giving birth and experiencing abortions did not differ between the two groups (live births, P=0.21 and abortions, P=0.12). Also birth weight, length, Apgar score, and gestation length at abortion did not differ. Within the first year after the diagnosis was made, gestation length was lower in women with PHPT than that in controls. However, this was linked to more deliveries by caesarian sections. CONCLUSIONS A diagnosis of PHPT did not seem to increase the rate of abortions in our study. Reducing the abortion risk may therefore not be an indication for parathyroidectomy during pregnancy in patients with mild PHPT. The PHPT diagnosis does not seem to affect birth weight, length and Apgar score. The higher number of deliveries by cesarean section after the diagnosis was made may be associated with lower gestation age. The strategy for delivery should be carefully considered in pregnant women with PHPT.
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Affiliation(s)
- Ali Abood
- Faculty of MedicineAarhus University, Aarhus, DenmarkDepartment of EndocrinologyAalborg University Hospital, Aalborg, DenmarkClinical InstituteAalborg University, Aalborg, Denmark
| | - Peter Vestergaard
- Faculty of MedicineAarhus University, Aarhus, DenmarkDepartment of EndocrinologyAalborg University Hospital, Aalborg, DenmarkClinical InstituteAalborg University, Aalborg, DenmarkFaculty of MedicineAarhus University, Aarhus, DenmarkDepartment of EndocrinologyAalborg University Hospital, Aalborg, DenmarkClinical InstituteAalborg University, Aalborg, Denmark
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Concurrent Parathyroidectomy and Caesarean Section in the Third Trimester. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:502-505. [DOI: 10.1016/s1701-2163(15)30564-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Baretić M, Tomić Brzac H, Dobrenić M, Jakovčević A. Parathyroid carcinoma in pregnancy. World J Clin Cases 2014; 2:151-156. [PMID: 24868516 PMCID: PMC4023310 DOI: 10.12998/wjcc.v2.i5.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/20/2014] [Accepted: 04/03/2014] [Indexed: 02/05/2023] Open
Abstract
A 24-year-old female patient with parathyroid carcinoma, the rarest endocrine malignancy, had two pregnancies. In the first pregnancy, she had severe nausea and fatigue. Hypercalcemia and hyperparathyroidism were diagnosed in the postpartum period. Hyperemesis gravidarum masked a diagnosis of hypercalcemia. Neck ultrasound and Tc-99m sestamibi found an enlarged lower right parathyroid gland. The gland was surgically removed, and an initial pathology report described atypical adenoma. Shortly afterward, she became pregnant again. During the second pregnancy, her calcium level was frequently controlled but was always in the normal range. Normocalcemia is explained by the specific physiology of pregnancy accompanied by hemodilution, hypoalbuminemia and maternal hypercalciuria (mediated by increased glomerular filtration). During lactation, calcium levels rose, and a new neck ultrasound showed a solitary mass in the area of prior surgery and an enlarged pretracheal lymph node. Fine needle aspiration of the solitary mass and node showed parathyroid carcinoma cells. The tumor mass was resected en bloc with the contiguous tissues and surrounding lymph nodes (pathology report; parathyroid carcinoma with metastases). Over the next five years, four consecutive surgeries were performed to remove malignant parathyroid tissue, lymph nodes and local metastases. Following the surgical procedures, no hypocalcemia was observed. More serious hypercalcemia recurred; the calcium level was difficult to control with a combination of pamidronate, cinacalcet and loop diuretic. No elements of multiple endocrine neoplasia were present.
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Hession P, Walsh J, Gaffney G. Two cases of primary hyperparathyroidism in pregnancy. BMJ Case Rep 2014; 2014:bcr2013202883. [PMID: 24469844 PMCID: PMC3912382 DOI: 10.1136/bcr-2013-202883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Two women suffering from primary hyperparathyroidism in pregnancy are presented. Patient 1 with a history of four miscarriages, an ectopic pregnancy and a sixth pregnancy complicated by severe early onset preeclampsia. She was found to have high serum Ca(2+) levels after delivery and parathyroid adenoma was diagnosed by ultrasound. A right inferior parathyroidectomy was performed. Patient 2 with a history of high serum Ca(2+) and generalised symptoms of hypercalcaemia. Ultrasound did not reveal adenoma but an elective neck exploration was performed in light of the abnormal blood results. The right inferior parathyroid gland was excised and histology confirmed the presence of adenoma. These cases help highlight the different ways in which primary hyperparathyroidism can present and the barriers to diagnosis in pregnancy. Various potential complications (including miscarriage and preeclampsia) are explored and the appropriateness of surgical treatment during pregnancy is emphasised.
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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
Parathyroid disorders are not common among pregnant women, but harbor a significant morbidity and mortality potential if they remain unrecognized and untreated. The symptoms caused by abnormally low or high blood free calcium level are mostly non-specific in the initial stages, thus when recognized might pose a real danger. Here we will survey the alterations in calcium metabolism induced by pregnancy, and describe the clinical manifestations, diagnosis and treatment of parathyroid and other calcium metabolism disorders during pregnancy. The current literature on the impact of calcium and vitamin D deficiency during pregnancy will also be reviewed.
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Affiliation(s)
- Ilana Parkes
- Department of Obstetrics & Gynecology, Hadassah Ein Kerem University Hospital, Jerusalem, Israel
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Abstract
Endocrine disease is common in pregnancy. Most pre-existing endocrine conditions, if well controlled, have little impact on maternal or fetal morbidity. Uncontrolled endocrine conditions in pregnancy, whether poorly controlled pre-conception or newly diagnosed, are associated with a variety of adverse fetal outcomes and maternal morbidity. Also, transplacental transfer of maternal antibodies can have adverse fetal or neonatal consequences. The initial diagnosis of many conditions is hindered by the overlap of symptoms that occur in normal pregnancy and those that suggest specific endocrine pathologies, and also by the changes in reference ranges for common biochemical measurements that occur as a result of physiological changes in pregnancy. This article summarises the common endocrine disorders in pregnancy and describes how pregnancy can alter their investigation, treatment and ongoing management, as well as the potential effects on the fetus.
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El Ouahabi H, Salhi H, Boujraf S, Ajdi F. Hungry bone disease in a pregnant woman with parathyroid adenoma. Indian J Endocrinol Metab 2012; 16:666-668. [PMID: 22837946 PMCID: PMC3401786 DOI: 10.4103/2230-8210.98045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hanan El Ouahabi
- Department of Endocrinology, University Hospital of Fez, Fez, Morocco
| | - Houda Salhi
- Department of Endocrinology, University Hospital of Fez, Fez, Morocco
| | - Saïd Boujraf
- Department of Biophysics and Clinical MRI Methods, University of Fez, Fez, Morocco
| | - Farida Ajdi
- Department of Endocrinology, University Hospital of Fez, Fez, Morocco
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The Detection and Management of Primary Hyperparathyroidism in Patients with Urolithiasis. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Paul RG, Elston MS, Gill AJ, Marsh D, Beer I, Wolmarans L, Conaglen JV, MeyerRochow GY. Hypercalcaemia due to parathyroid carcinoma presenting in the third trimester of pregnancy. Aust N Z J Obstet Gynaecol 2011; 52:204-7. [DOI: 10.1111/j.1479-828x.2011.01391.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Pregnancy and lactation are associated with profound changes in calcium physiology. This can make interpretation of biochemical tests difficult during these times. Diseases of bone and calcium metabolism are uncommon during pregnancy but can be severe when they occur. These conditions are complicated by the need for dual consideration for the maternal and foetal health. These conditions are also much less well studied than related conditions that occur outside of pregnancy resulting in a reduction in evidence for and confidence in recommendations relating to management. This chapter will review the changes in calcium physiology that occur with pregnancy and lactation, describe the disorders of calcium and parathyroid physiology that can occur and outline the most appropriate way to manage these conditions.
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Affiliation(s)
- Mark S Cooper
- Centre for Endocrinology, Diabetes and Metabolism, Institute for Biomedical Research, School of Clinical and Experimental Medicine, University of Birmingham, UK.
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45
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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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Baumann K, Weichert J, Krokowski M, Diedrich K, Banz-Jansen C. Coexistent parathyroid adenoma and thyroid papillary carcinoma in pregnancy. Arch Gynecol Obstet 2011; 284:91-4. [DOI: 10.1007/s00404-011-1903-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 03/24/2011] [Indexed: 12/01/2022]
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McMullen TPW, Learoyd DL, Williams DC, Sywak MS, Sidhu SB, Delbridge LW. Hyperparathyroidism in pregnancy: options for localization and surgical therapy. World J Surg 2010; 34:1811-6. [PMID: 20386905 DOI: 10.1007/s00268-010-0569-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyperparathyroidism in pregnancy is a threat to the health of both mother and fetus. The mothers suffer commonly from nephrolithiasis, hyperemesis, or even hypercalcemic crisis. Untreated disease will commonly complicate fetal development and fetal death is a significant risk. Treatment options, including medical and surgical therapy, are debated in the literature. METHODS This is a case series comprising seven patients with primary hyperparathyroidism in pregnancy. Data collected included symptoms at diagnosis, biochemical abnormalities, pathologic findings, treatment regimes, and subsequent maternal and fetal outcomes. RESULTS Seven women, aged 20 to 39 years, presented with hyperparathyroidism during pregnancy. The earliest presented at 8 weeks and the latest at 38 weeks. Four of seven patients experienced renal calculi. Calcium levels were 2.7-3.5 mmol/l. All were found to have solitary parathyroid adenomas, of which two were in ectopic locations. Fetal complications included three preterm deliveries and one fetal death with no cases of neonatal tetany. Maternal and fetal complications could not be predicted based on duration or severity of hypercalcemia. Three patients were treated during pregnancy with surgery, and two of these had ectopic glands that required reoperations with a novel approach using Tc-99m sestamibi scanning during pregnancy to assist in localizing the abnormal gland. Four cases were treated postpartum with a combination of open and minimally invasive approaches after localization. No operative complications or fetal loss related to surgery were observed in this cohort. CONCLUSIONS Primary hyperparathyroidism in pregnancy represents a significant risk for maternal and fetal complications that cannot be predicted by duration of symptoms or serum calcium levels. Surgical treatment should be considered early, and a minimally invasive approach with ultrasound is best suited to mitigating risk to mother and fetus. Equally important, Tc-99m sestamibi imaging may be used safely for localization of the parathyroids after negative cervical explorations.
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Affiliation(s)
- Todd P W McMullen
- Department of Surgery 2D, Walter C. Mackenzie Health Science Centre, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
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Owen RP, Chou KJ, Silver CE, Beilin Y, Tang JJ, Yanagisawa RT, Rinaldo A, Shaha AR, Ferlito A. Thyroid and parathyroid surgery in pregnancy. Eur Arch Otorhinolaryngol 2010; 267:1825-35. [PMID: 20878196 DOI: 10.1007/s00405-010-1390-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 09/06/2010] [Indexed: 11/29/2022]
Abstract
The consideration of surgery during pregnancy requires weighing the benefit of urgent surgery against the risk to mother and fetus. Surgery during pregnancy involves an increase in both maternal and fetal risks. Thyroid and parathyroid surgery involves physiological risks to both mother and fetus specific to the disease and function of these endocrine glands. Evaluation of a thyroid mass is similar in pregnant patients with ultrasound and fine-needle aspiration biopsy providing the most important information, while the use of radiographic imaging is severely constrained except when specifically required. In general, thyroid surgery can be delayed until after delivery except in cases of airway compromise or aggressive cancer. In contrast, parathyroid surgery is recommended during pregnancy to avoid adverse effects to the neonate.
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Affiliation(s)
- Randall P Owen
- Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Mount Sinai School of Medicine, New York, NY, USA
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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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