851: Impact of perinatal primary hyperparathyroidism on maternal and fetal/neonatal outcomes

Abstract

To provide a thorough description of maternal, fetal and neonatal outcomes associated with primary hyperparathyroidism (pHPT) in the contemporary setting, permitting a better understanding of the implication of pHPT in pregnancy. A retrospective case series at a Canadian tertiary-care referral center including 23 pregnancies in 19 women diagnosed with pHPT either pre-conceptionally, during gestation or within 6 weeks postpartum. An extensive evaluation of perinatal outcomes is presented. Over a period of 17.5-years, 19 women (with 23 pregnancies) were diagnosed with pHPT; typically mid- pregnancy. Most women (79%) were symptomatic at presentation, though often with non-specific manifestations. While 14% of pregnancies were affected by maternal/obstetric complications, fetal complications were observed in 45% of pregnancies for which data were available. Mild hypercalcemia (with accompanied hypophosphatemia in 46% and hypomagnesemia in 36%) was present in 57%, yet surgical intervention was the treatment of choice in 89%, and no complications were encountered. In contrast, of the two medically managed women with mild hypercalcemia, one term infant required NICU admission for hypercalcemia. Normal calcium levels in those treated before conception did not fully eliminate perinatal risk. The rates of maternal and fetal/neonatal complications in our series are more reassuring than the ubiquitously quoted rates, which are based on small and now dated studies. The diagnosis of pHPT may be easily missed during pregnancy, owing to the non-specific symptoms with which it presents. A high-index of suspicion leading to measurement of ionized calcium levels is encouraged, especially in cases of excessive nausea/vomiting, nephrolithiasis, atypical presentation of hypertensive disorders, or isolated polyhydramnios, and mild degrees of calcium derangement should not be assumed to be fully protective. Indeed, the attenuated rate of complications noted may have been the result of surgical intervention in a large proportion of participants, though this will require verification via meta-analysis or future prospective work.View Large Image Figure ViewerDownload Hi-res image Download (PPT)