Parathyroid surgery in pregnancy: review of the literature and localization by aspiration for parathyroid hormone levels

Abstract

To review the management of primary hyperparathyroidism in pregnant women by focusing on the use of preoperative localization procedures and minimally invasive parathyroid surgery during pregnancy. We report the clinical course of two pregnant women with severe hypercalcemia due to primary hyperparathyroidism, as well as review the literature. Primary hyperparathyroidism in pregnant women is associated with high prevalence of maternal and neonatal complications. In women, with severe hypercalcemia, parathyroid surgery during pregnancy reduces fetal and maternal morbidities. Preoperative localization of parathyroid adenomas during pregnancy remains challenging. In selected cases aspiration of nodules suspected of being parathyroid adenomas with the measurement of the parathyroid hormone (PTH) from the aspirate can localize the adenoma, and allow the surgeon to carry out a minimally invasive parathyroidectomy. Localization of a suspected parathyroid adenoma by ultrasound-guided aspiration of a lesion and the measurement of the PTH has previously been described in non-pregnant women. Our review of the literature did not identify any previous case of a pregnant woman with primary hyperparathyroidism, where preoperative localization of a parathyroid adenoma was accomplished by aspiration of a suspected lesion followed by a successful minimally invasive parathyroidectomy carried out during pregnancy.