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.
Highlights
Primary hyperparathyroidism (PHPT) is a relatively common endocrine disorder and represents the most common cause of hypercalcemia in the non-pregnant population [1]
The diagnosis of PHPT in pregnancy can be confirmed in the presence of hypercalcemia with a non-suppressed parathyroid hormone (PTH) level
We carried out a literature search on MEDLINE, CINAHL, EMBASE and Google scholar databases from 1 January 1990 to 31 December 2020 using the following keywords: hyperparathyroidism; pregnancy; calcium homeostasis; parathyroidectomy; gestational hyperparathyroidism; cinacalcet; nephrolithiasis; preeclampsia; hypercalcemia
Summary
Primary hyperparathyroidism (PHPT) is a relatively common endocrine disorder and represents the most common cause of hypercalcemia in the non-pregnant population [1]. Among 292,042 women of reproductive age, PHPT was present in 0.05%. The diagnosis of PHPT in pregnancy can be confirmed in the presence of hypercalcemia (elevated serum ionized calcium or calcium adjusted for albumin) with a non-suppressed parathyroid hormone (PTH) level. In individuals below the age of 40 years, PHPT may be due to an underlying genetic mutation which occurs in approximately 10% of the cases [13]. Since pregnant women represent a considerably younger population, the presence of an underlying genetic mutation may be expected to be greater than 10%. Calcium homeostasis during pregnancy has been presented in detail in the accompanying article on hypoparathyroidism in pregnancy [23]
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