Clinical Presentation, Management, and Outcomes of Primary Hyperparathyroidism During Pregnancy

Overview

Journal Int J Endocrinol

Publisher Wiley

Specialty Endocrinology

Date 2017 Nov 18

PMID 29147113

Citations 15

Authors

Ya Hu

Ming Cui

Zhengyi Sun

Zhe Su

Xiang Gao

Quan Liao

Yupei Zhao

Affiliations

Soon will be listed here.

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.

Citing Articles

Pregnancy Complicated by Primary Hyperparathyroidism-A Case Report on the Use of Cinacalcet.

Goncalves J, Freitas G, Souto S, Rodrigues T, Sa Couto P, Belo S Clin Case Rep. 2025; 13(3):e70305.

PMID: 40051898 PMC: 11882751. DOI: 10.1002/ccr3.70305.

Challenges in the management of hypercalcemia in pregnancy - Case report of two cases.

Lim S, Lim W, Thain S Case Rep Womens Health. 2024; 41:e00586.

PMID: 38356696 PMC: 10864752. DOI: 10.1016/j.crwh.2024.e00586.

Case report: Microwave ablation is a safe and effective method for primary hyperparathyroidism in pregnancy.

Luo Y, Lv Q, Xu Z, Fang J, Pu H, Gao Y Front Med (Lausanne). 2024; 11:1204696.

PMID: 38298816 PMC: 10827987. DOI: 10.3389/fmed.2024.1204696.

Association of hypertension in pregnancy with serum electrolyte disorders in late pregnancy among Cameroonian women.

Ajong A, Yakum M, Aljerf L, Ali I, Mangala F, Onydinma U Sci Rep. 2023; 13(1):20940.

PMID: 38017060 PMC: 10684507. DOI: 10.1038/s41598-023-47623-6.

Expert consensus on multidisciplinary approach to the diagnosis and treatment of primary hyperparathyroidism in pregnancy in China.

Zhong H, Liao Q, Liu J Endocrine. 2023; 82(2):282-295.

PMID: 37221429 DOI: 10.1007/s12020-023-03392-w.

References

Gilat H, Cohen M, Feinmesser R, Benzion J, Shvero J, Segal K . Minimally invasive procedure for resection of a parathyroid adenoma: the role of preoperative high-resolution ultrasonography. J Clin Ultrasound. 2005; 33(6):283-7. DOI: 10.1002/jcu.20131. View

Bilezikian J, Khan A, Potts Jr J . Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009; 94(2):335-9. PMC: 3214274. DOI: 10.1210/jc.2008-1763. View

MAZZE R, Kallen B . Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol. 1989; 161(5):1178-85. DOI: 10.1016/0002-9378(89)90659-5. View

Walker A, Fraile J, Hubbard J . "Parathyroidectomy in pregnancy"-a single centre experience with review of evidence and proposal for treatment algorithim. Gland Surg. 2014; 3(3):158-64. PMC: 4139131. DOI: 10.3978/j.issn.2227-684X.2014.02.04. View

Dochez V, Ducarme G . Primary hyperparathyroidism during pregnancy. Arch Gynecol Obstet. 2014; 291(2):259-63. DOI: 10.1007/s00404-014-3526-8. View

Herrera-Martinez A, Bahamondes-Opazo R, Palomares-Ortega R, Munoz-Jimenez C, Galvez-Moreno M, Quesada Gomez J . Primary hyperparathyroidism in pregnancy: a two-case report and literature review. Case Rep Obstet Gynecol. 2015; 2015:171828. PMC: 4393898. DOI: 10.1155/2015/171828. View

Carella M, Gossain V . Hyperparathyroidism and pregnancy: case report and review. J Gen Intern Med. 1992; 7(4):448-53. DOI: 10.1007/BF02599166. View

Van de Velde M, De Buck F . Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol. 2007; 73(4):235-40. View

Kokrdova Z . Pregnancy and primary hyperparathyroidism. J Obstet Gynaecol. 2010; 30(1):57-9. DOI: 10.3109/01443610903315611. View

10.

Van Calsteren K, Heyns L, De Smet F, Van Eycken L, Gziri M, van Gemert W . Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol. 2009; 28(4):683-9. DOI: 10.1200/JCO.2009.23.2801. View

11.

Norman J, Politz D . Prospective study in 3,000 consecutive parathyroid operations demonstrates 18 objective factors that influence the decision for unilateral versus bilateral surgical approach. J Am Coll Surg. 2010; 211(2):244-9. DOI: 10.1016/j.jamcollsurg.2010.03.040. View

12.

Abood A, Vestergaard P . Pregnancy outcomes in women with primary hyperparathyroidism. Eur J Endocrinol. 2014; 171(1):69-76. DOI: 10.1530/EJE-13-0966. View

13.

Kort K, Schiller H, Numann P . Hyperparathyroidism and pregnancy. Am J Surg. 1999; 177(1):66-8. DOI: 10.1016/s0002-9610(98)00302-x. View

14.

Norman J, Politz D, Politz L . Hyperparathyroidism during pregnancy and the effect of rising calcium on pregnancy loss: a call for earlier intervention. Clin Endocrinol (Oxf). 2009; 71(1):104-9. DOI: 10.1111/j.1365-2265.2008.03495.x. View

15.

Vitetta G, Neri P, Chiecchio A, Carriero A, Cirillo S, Balbo Mussetto A . Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy. J Ultrasound. 2014; 17(1):1-12. PMC: 3945200. DOI: 10.1007/s40477-014-0067-8. View

16.

Alharbi B, Ali Alqahtani M, Hmoud M, Alhejaili E, Badros R . Preeclampsia: A Possible Complication of Primary Hyperparathyroidism. Case Rep Obstet Gynecol. 2016; 2016:7501263. PMC: 4909923. DOI: 10.1155/2016/7501263. View

17.

Pothiwala P, Levine S . Parathyroid surgery in pregnancy: review of the literature and localization by aspiration for parathyroid hormone levels. J Perinatol. 2009; 29(12):779-84. DOI: 10.1038/jp.2009.84. View

18.

Naru T, Khan R, Khan M . Primary hyperparathyrodism in pregnancy and review of literature. J Pak Med Assoc. 2011; 61(4):401-3. View

19.

Duncan P, Pope W, COHEN M, Greer N . Fetal risk of anesthesia and surgery during pregnancy. Anesthesiology. 1986; 64(6):790-4. DOI: 10.1097/00000542-198606000-00019. View

20.

Lee C, Chao A, Chang Y, Peng H, Wang T, Chao A . Acute pancreatitis secondary to primary hyperparathyroidism in a postpartum patient: a case report and literature review. Taiwan J Obstet Gynecol. 2014; 53(2):252-5. DOI: 10.1016/j.tjog.2013.01.029. View