Pregnancy with primary hyperparathyroidism: analysis of five cases

Abstract

Objective To study the clinical presentations, diagnosis and managements of primary hyperparathyroidism (pHPT) in pregnancy. Methods A total of five cases of pHPT in pregnancy were enrolled from January 2005 to December 2014 in Peking Union Medical College Hospital. Their clinical presentations, managements, maternal-fetal complications and pregnancy outcomes were retrospectively analyzed. Results The median age was 32 (29, 41) years. Of the five cases, three were diagnosed in the second trimester, one was before pregnancy and one was after delivery. Most of the clinical symptoms were nonspecific to pHPT, such as nausea, vomiting and loss of appetite. Frequent urination and nocturia occurred in one; unconsciousness and manifestations of acute pancreatitis and eclampsia relevant symptoms were complained of by one. The common maternal complications were nephrolithiasis and hydronephrosis (3/5), osteoporosis (2/5), anemia (2/5) and kaliopenia (2/5), while the severe complications were hypercalcemic crisis (2/5), acute pancreatitis (1/5), eclampsia (1/5), HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome (1/5), disseminated intravascular coagulation (DIC) (1/5), cerebral infarction (1/5) and intrauterine fetal death of one twin (1/5). The median level of calcium in serum samples was 3.70 (2.78, 4.50) mmol/L; the median level of parathyroid hormone (PTH) in serum samples was 294 (151, 634) pg/ml. All of the five cases were positive for parathyroid ultrasonography. Four cases received parathyroid radionuclide imaging and had positive results. One asymptomatic patient received no specific treatment, whereas the neonate presented with hypocalcemia after birth. Two cases received surgical resections in the second trimester; one of them had a live birth without fetal complication, while the other had induced abortion. Two cases received postpartum surgery; one asymptomatic patient had a live birth without fetal complication, while the other with twin pregnancy suffered stillbirths (one intrauterine fetal death and one neonatal death). Pathologic diagnosis were solitary parathyroid adenomas in four cases who received surgery. Their operations were effective except that one case, which was improved after treatment, was complicated with secondary hypoparathyroidism. Conclusions The symptoms of pHPT in pregnancy are often nonspecific, but it can cause maternal and fetal morbidity and mortality. Early diagnosis of pHPT, followed by appropriate managements, has been shown to significantly reduce the complications. Surgical management should be a safe and effective choice. Key words: Hyperparathyroidism, primary; Pregnancy complications