Hyperparathyroidism In Pregnancy Research Articles

Primary hyperparathyroidism in pregnancy after in vitro fertilization

Primary hyperparathyroidism (PHPT) in pregnant women is a rare condition, often remaining undiagnosed due to non-specific clinical symptoms. However, it can lead to life-threatening complications for both the mother and fetus. In vitro fertilization (IVF) is also associated with an increased probability of adverse outcomes compared to the general population. Timely diagnostics and personalized treatment, taking into account the extremely high risk of complications if PHPT and pregnancy result from IVF, require attention of healthcare professionals and formation of a multidisciplinary team.

Primary hyperparathyroidism in pregnancy

Primary hyperparathyroidism in pregnancy

OBSTETRICAL AND NEONATAL OUTCOMES AMONG PREGNANCIES COMPLICATED BY HYPERPARATHYROIDISM: SYSTEMATIC REVIEW

Background: Primary hyperparathyroidism (PHPT) is a relatively common disorder of the parathyroid glands, causing skeletal, renal, and cardiac complications. As etiological features of PHPT, single adenoma, hyperplasia, carcinoma, and familiar causes (MEN multiple endocrine neoplasia, FHH familiar hypocalciuric hypercalcemia, hyperparathyroidismjaw tumor syndrome) are presented. Primary hyperparathyroidism in pregnancy has an incidence of 1, which is underestimated due to the plethora of undiagnosed cases. The aim: This study aims to show about obstetrical and neonatal outcomes among pregnancies complicated by hyperparathyroidism. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 10 articles, whereas the results of our search on SagePub brought up 60 articles. The results of the search conducted for the last year of 2013 yielded a total 2 articles for PubMed and 14 articles for SagePub. The result from title screening, a total 1 articles for PubMed and 10 articles for SagePub. In the end, we compiled a total of 7 papers. We included five research that met the criteria. Conclusion: Pregnancy complicated by PHPT may lead to serious maternal and infant complications. MDT consultation ensures timely diagnosis, comprehensive treatment for the patients and better pregnancy outcomes.

Primary Hyperparathyroidism in Pregnancy

Primary Hyperparathyroidism in Pregnancy

SAT195 A Curious Case Of Severe Reversible PTH-mediated Hypercalcemia Of Pregnancy

Abstract Disclosure: I. Albanese: None. N. Nicolas: None. S.S. Wing: Grant Recipient; Self; Pfizer Global R&D. Other; Self; Almac Discovery (Independent Contractor). E. Mitmaker: None. L. Vautour: None. Background: Primary hyperparathyroidism is rarely diagnosed in pregnancy as symptoms may overlap with those of pregnancy and biochemical diagnosis may be masked by physiologic changes in calcium homeostasis. Hyperparathyroidism in pregnancy is associated with increased maternal and fetal complications. While mild disease is treated conservatively, moderate to severe disease is generally treated surgically in the second trimester. Safe pharmacotherapy options are limited in pregnancy. Case: A 35-year-old woman G3P1 at 10 weeks presented to our institution with polyuria, bone pain and weakness with labs demonstrating severe hypercalcemia (Calcium total: 3.82mmol/L (normal: 2.12-2.62); PTHi: 12pmol/L (normal: 1.5-9.3)). PTHrP was suppressed. She had a prior history of PTH-mediated hypercalcemia in her first pregnancy. She previously underwent three exploratory surgeries in which only three parathyroid glands were found and removed. The hyperparathyroidism and hypercalcemia persisted post-operatively thus she also required intravenous fluids, calcitonin and cinacalcet. The pregnancy was otherwise uncomplicated. Post-partum, she developed hypoparathyroidism and hypocalcemia. Throughout this current pregnancy, multiple imaging modalities were used (ultrasound, MRI and parathyroid sestamibi), none of which were unable to localize any hyperfunctioning parathyroid tissue. Thus, management was limited to medical therapy. Despite aggressive hydration, calcitonin and cinacalcet, total calcium and PTH levels consistently rose reaching peaks of 4.06mmol/L and 45.4pmol/L, respectively. Given hypercalcemia severity and associated neurological symptoms, she was also given bisphosphonates (pamidronate 60mg and zoledronic acid 4mg). She underwent C-section at 25+3 weeks due to fetal decelerations and placental insufficiency. She again developed hypoparathyroidism and hypocalcemia 1-week post-partum. Genetic testing was negative for any causes of hyperparathyroidism. Discussion: This is a unique case of severe PTH-mediated hypercalcemia in that the exact mechanism is unknown but appears to be pregnancy-mediated and reversible such that it only occurs in pregnancy with subsequent hypoparathyroidism post-partum. Investigations to better elucidate the mechanism of this are ongoing. Presentation: Saturday, June 17, 2023

Diagnostic et prise en charge d’hyperparathyroïdie primaire pendant la grossesse : revue de la littérature autour d’un cas

ObjectiveThere is no specific recommendation for management in pregnant women: the aim of this review, based on a clinical case study, is to clarify its development, complications, risk factor and treatment. MethodsA review of the literature was performed by consulting the Pubmed, Cochrane Library, and Science Direct databases. ResultsPrimary hyperparathyroidism is defined as excessive production of parathyroid hormone resulting in hypercalcemia. The prevalence of primary hyperparathyroidism during pregnancy is not known. Indeed, the symptomatology, related to hypercalcemia, is not very specific and easily confused with the clinical manifestations of pregnancy. The physiological changes specific to the pregnant state frequently lead to a slight hypocalcemia which may complicate the diagnosis of primary hyperparathyroidism. Primary hyperparathyroidism results from a parathyroid adenoma in the majority of cases and is detected by ultrasound during pregnancy. Primary hyperparathyroidism in pregnancy causes significant risks to both mother and fetus. The maternal complication rate is 14–67%, however, the most serious complication is hypercalcemic crisis, which requires increased surveillance in the postpartum period. Obstetrical complications are also induced by primary hyperparathyroidism, such as acute polyhydramnios, or intrauterine growth retardation. The fetal complication rate can reach 45–80% of cases with neonatal hypocalcemia as the main complication. If medical treatment is based on hyperhydration, only surgical treatment is curative. ConclusionSurgery should be proposed to symptomatic patients or those with high blood calcium levels, discussed in interdisciplinary committee and should be organized ideally in the second trimester to avoid maternal and fetal complications.

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

Primary hyperparathyroidism in pregnancy is a rare disease that can have detrimental effects on both maternal and fetal/neonatal outcomes. The physiological changes that occur during pregnancy can complicate the diagnosis, imaging examinations, and treatment of this disorder. To enhance our understanding and management of primary hyperparathyroidism in pregnancy, experts from various fields, including endocrinology, obstetrics, surgery, ultrasonography, nuclear medicine, pediatrics, nephrology, and general practice in China, collaborated to develop a consensus addressing the critical aspects of the diagnosis and treatment of primary hyperparathyroidism in pregnancy with a multidisciplinary team approach. This consensus provides valuable guidance for healthcare professionals in managing this condition, ultimately improving outcomes for both mothers and their babies.

Primary hyperparathyroidism in pregnancy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Primary Hyperparathyroidism in Pregnancy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Primary hyperparathyroidism in pregnancy: A case report

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Hyperparathyroidism in pregnancy, should we favour surgical intervention?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Abstract #1324626: Primary Hyperparathyroidism Presenting as Hyperemesis Gravidarum in Pregnancy

Primary hyperparathyroidism is uncommon during pregnancy. Physiologic changes in calcium-regulating hormones make the diagnosis more challenging. Furthermore, nausea and vomiting are common during pregnancy and can lead to hyperemesis gravidarum if severe or intractable. We present the case of a 29-year-old woman who was diagnosed with primary hyperparathyroidism in pregnancy.

Case Report: Hypercalcaemia due to Primary Hyperparathyroidism in Pregnancy

A 34-year-old pregnant patient presented at 6 weeks gestation for routine biochemistry tests with elevated serum calcium levels (measured Ca 2.78 mmol/L and calculated Ca 2.64 mmol/L; RI 2.10 to 2.60 mmol/L) with normal serum albumin (47 g/L; RI 37 – 48 g/L). Subsequent presentations showed persisting high Ca and ionised Ca, with normal serum parathyroid hormone (PTH) (2.7 pmol/L; RI 1.5 – 7.5 pmol/L), serum PO4, vitamin D and normal renal markers. Urine Ca excretion was within reference limits. Following an early miscarriage serum Ca levels normalised while PTH progressively increased. (5.6 at 9 weeks gestation and 7.7 at 13 weeks gestation (1.5 – 75 pmol/L). A parathyroid adenoma was diagnosed on imaging and a left superior parathyroidectomy was performed. Post-operative blood results suggested resolution of hyperparathyroidism. Her second pregnancy too, spontaneously aborted after 6 weeks of gestation despite Ca remaining within normal limits. Thyroid function remained normal, and there was no clinical suspicion of MEN. All other major causes of early pregnancy loss were screened for and excluded. The patient presented again in early pregnancy with no known complication and normal serum PTH (2.1 pmol/L; RI 1.5 – 7.5 pmol/L) and progressed to full term. (Figure 1) shows the measured and calculated serum Ca and PTH levels during the period of testing.

ODP115 Primary Hyperparathyroidism in Pregnancy

Abstract Introduction Primary hyperparathyroidism (HPT) is characterized by an overproduction of parathyroid hormone (PTH) by a parathyroid adenoma, parathyroid hyperplasia, or parathyroid carcinoma classically causing hypercalcemia. Incidence of this pathology during pregnancy is very low (1%), as the great majority of cases are diagnosed in adults >45 years old. When present,it can be associated with detrimental maternal and fetal outcomes. Complications may include maternal nephrolithiasis, hyperemesis, and pancreatitis, along with miscarriage, fetal demise, low birth weight, neonatal hypocalcemia, and tetany. Considering the incidence of HPT in pregnancy is uncommon, there is limited data regarding diagnostic and treatment options for these patients. Clinical Case This is the case of a 28-year-old pregnant female at 12 weeks gestational age (WGA) who had a history of Type 1 Diabetes Mellitus. She was evaluated regarding metabolic control during pregnancy, however, was incidentally found with hypercalcemia. She denied any history of fractures, abdominal discomfort, bone pains or nephrolithiasis; she also had no pertinent family history associated with hypercalcemia. Laboratories showed a calcium level of 14.9 md/dL (nl, 8.6-10.2) with a phosphorus level of 1.9 mg/dL (nl, 2.5-4.5), which raised the suspicion of HPT. Further workup demonstrated high parathyroid hormone (PTH) 245 pg/mL (nl, 18.4-80.1), vitamin D-25-OH 24.7 ng/mL (nl, 30-100) and 24hr urine calcium collection of 402.5 mg/24hr (nl, 100-300); the latter excluding the possibility of familial hypocalciuric hypercalcemia. Patient was managed conservatively with IV hydration resulting in mild improvement of calcium to 12.4 mg/dL. Thyroid/Neck ultrasound revealed a thyroid gland with normal homogeneous texture and no distinct focal vascularized structure to suggest parathyroid origin. Other diagnostic imaging for localization of parathyroid disease with technetium-99m methoxyisobutylisonitrile parathyroid scintigraphy or single-photon emission Computed Tomography are not recommended in pregnancy due to insufficient safety data and radiation risk. After discussion with a multidisciplinary team including endocrine surgeons, endocrinologists, and obstetricians, an exploratory neck surgery for possible parathyroidectomy was recommended. She underwent surgery at 13 WGA where a left superior adenoma was identified and completely removed without complications. Intraoperative PTH levels revealed a pre-excision PTH of 342 pg/mL (18.4-80.1), post-excision PTH at 5 minutes of 76 pg/mL, and at 10 minutes of 50 ng/mL, suggestive of successful surgical removal. Pathology report was consistent with left superior parathyroid adenoma. Both calcium and phosphorus levels normalized post-surgery [Ca 9.6 mg/dL (nl, 8.6-10.2) and 2.7 mg/dL (2.5-4.5)]. Conclusion This is an unusual case of a patient with asymptomatic severe hypercalcemia associated to HPT diagnosed during pregnancy. In this patient conservative medical treatment proved to be unsuccessful. Parathyroidectomy early on the 2 nd trimester was advantageous to avoid both maternal and fetal complications during pregnancy. Presentation: No date and time listed

Primary hyperparathyroidism in pregnancy: experience of a tertiary centre

Background and purposeThe management of primary hyperparathyroidism (PHPT) during pregnancy is challenging and there is no clear consensus on whether it increases the risk of complications in pregnancy. We conducted this study to review the maternal and fetal outcomes of pregnant women treated for PHPT in a single centre.MethodsData on relevant clinical parameters, demographics, management strategies, maternal and fetal outcomes were collected from the medical records of pregnant patients with PHPT diagnosed between 2012 and 2019.ResultsOf 15 pregnant women with PHPT, 6 were managed medically and 9 underwent surgery. The median age at their index pregnancy was 28 years [range 19–42]. The median highest adjusted calcium level in the medical group was 2.90 [range 2.61–3.25] mmol/L vs. 3.11 [2.78–4.95] mmol/L in the surgical group. There was one miscarriage and the stillbirth of twins in the medical group, but no such outcomes in the surgical group. The median gestational ages were 39 + 3 weeks [range 24 + 2–41 + 2 weeks] and 39 + 4 weeks [range 37 + 1–39 + 5 weeks] in the medical and surgical groups, respectively. No birth was complicated by neonatal tetany or convulsions.ConclusionMore complications developed in the pregnant PHPT patients who were managed medically than in those who underwent surgery. Surgery performed during the second trimester resulted in good outcomes. Multi-centre prospective studies are required to ascertain the risk of various complications in women with PHPT during pregnancy.

Management of severe and symptomatic primary hyperparathyroidism in the first trimester of unplanned pregnancy.

SummaryPrimary hyperparathyroidism (PHP) is the most common aetiology for hypercalcaemia. The incidence of PHP in pregnant women is reported to be 8/100 000 population/year. It presents a threat to the health of both mother (hyperemesis, nephrolithiasis) and fetus (fetal death, congenital malformations, and neonatal severe hypocalcaemia-induced tetany). However, there is a lack of clear guidance on the management of primary hyperparathyroidism in pregnancy. In this study, we describe the case of a 26-year-old female patient who presented with severe hypercalcaemia secondary to PHP and underwent successful parathyroid adenectomy under local anaesthesia.Learning pointsPrimary hyperparathyroidism is a rare complication in pregnancy, but the consequences for mother and fetus can be severe.A perceived risk of general anaesthesia to the fetus in the first trimester has resulted in a general consensus to delay parathyroid surgery to the second trimester when possible – although the increased risk of fetal loss may occur before planned surgery.If the patient presents with severe or symptomatic hypercalcaemia, minimally invasive surgery under local anaesthetic should be considered regardless of the gestational age of the pregnancy.

Abstract #1138880: Primary Hyperparathyroidism in Pregnancy Complicated by Severe Hypercalcemia and Variable Outcomes

Primary hyperparathyroidism (PHPT) is rare, occurring in 0.86% of the United States population. PHPT of pregnancy is rarer, occurring in one percent of pregnancies. Oftentimes, calcium is mildly elevated and does not result in maternal or fetal complications. However, when levels rise, serious issues can occur. These cases demonstrate various clinical courses in pregnant women with PHPT and severe hypercalcemia.

Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management.

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.

Primary Hyperparathyroidism in Pregnancy - Two Case Reports

Introduction: Primary hyperparathyroidism in pregnancy is rare, with a reported incidence of 1%. The physiological changes of pregnancy can mask its diagnosis. Primary hyperparathyroidism is characterized by the overproduction of parathyroid hormone (PTH) and results in hypercalcemia and a raised or inappropriately normal PTH.Maternal and fetal/neonatal complications are estimated to occur in 67 and 80% of untreated cases respectively. Maternal complications include nephrolithiasis, pancreatitis, hyperemesis gravidarum, pre-eclampsia and hypercalcemic crises. Fetal complications include intrauterine growth restriction; preterm delivery and an increased risk of miscarriage.Case reports Case 1: An 18-year old woman presented in her first pregnancy with a known history of MEN type 1. She was diagnosed at the age of 17 following an appendectomy. She has a strong family history and subsequent genetic test confirmed the diagnosis of MEN1. Pre-pregnancy parathyroid sestamibi scan showed bilateral parathyroid adenoma. MRI pituitary was in keeping with a pituitary microadenoma. She had a corrected calcium ranged between 2.7-3.3mmol/L and an inappropriately raised PTH of 24.1pg/ml. She underwent elective parathyroidectomy at 15 week gestation. Post operatively she remained normocalcaemic. She subsequently developed gestational diabetes and was induced at 34 + 3 weeks due to multiple episodes of hypoglycaemia, reduced fetal movement and suspected placental insufficiency. She had a good fetal outcome. Case 2: A 29-year-old woman in her first pregnancy presented with recurrent episodes of renal colic and imaging confirmed significant bilateral renal calculi. A diagnosis of primary hyperparathyroidism was made with adjusted calcium of 2.94 mmol/L (2.20-2.60) and inappropriately unsuppressed parathyroid hormone of 20.1pg/ml (1.6-6.9), along with ultrasound parathyroid. She was managed with fluid rehydration initially and parathyroidectomy was performed at 12 weeks due to persistently elevated serum calcium. Her genetic screening for MEN (multiple endocrine Neoplasia) was negative. Fetal growth was closely monitored and the rest of her pregnancy was uncomplicated. She had an assisted vaginal delivery at term with good fetal outcome.Learning Points: 1. The physiological changes of pregnancy can mask its diagnosis; hence a high index of suspicion is needed to diagnose primary hyperparathyroidism in pregnancy.2. Management with rehydration forms the cornerstone in mild cases and Parathyroidectomy is the definitive treatment and recommended in second trimester.3. Ultrasound is the only recommended imaging modality in pregnancy.4. Primary hyperparathyroidism can be genetically determined in 10% of cases. Genetic testing enables patients to be screened for the development of other syndrome-related diseases e.g. neuroendocrine tumours in MEN1.

Pre-Eclampsia Strikes: Could It Be Related This Gland?

Introduction: Primary hyperparathyroidism (PHPT) is rarely diagnosed in pregnancy and if left untreated has the potential to lead to serious maternal and neonatal complications. We describe a case of PHPT with associated complicated pre-eclampsia. Clinical Case29-year-old primigravida admitted at 33 + 6 weeks with fatigue, 10lbs weight gain and elevated BP. Labs revealed potassium 2.9 (3.5-5.2mmol/L), corrected serum calcium (Ca)11.62 (8.4-10.2mg/dL), ionized calcium 1.69 (1.15-1.33mmol/L), PTH 163.9 (15-65pg/mL) and vitamin D 24.6 (30-100ng/mL). Other labs were normal. Urine studies showed 315mg/24h proteinuria and urine calcium of 129.5 mg/24hrs (100-300mg/24hrs). She was started on magnesium sulphate along with labetalol for BP control, given betamethasone for stimulation of fetal lung maturity as well as potassium repletion. Hypercalcemia (HCa) was initially managed with fluids and Lasix intravenously. At 34 + 2 weeks she developed SOB, orthopnea, headaches with new 9lbs weight gain over 5 days and sustained BP elevation. Urgent C-section was done for pre-eclampsia with severe features. Post-operatively, she suffered from postpartum hemorrhage, managed with transfusion of packed red cells and transient placement of a Bakri balloon. Her HCa worsened with Ca 12.56 and cinacalcet was started after delivery. This coincided with gradual improvement of her BP and Ca to 10.8. She declined additional work-up and was discharged in stable condition. Clinical LessonPHPT often goes undiagnosed in pregnancy, with symptoms of fatigue and constipation mimicking common complaints of pregnancy. Studies have also suggested that up to 25% of patients with PHPT during pregnancy present with hypertension and pre-eclampsia and that there is an association between preeclampsia and the presence of parathyroid adenomas. The pathophysiology is unclear but is thought to be due to endothelial dysfunction triggered by hypercalcemia as well as abnormal placentation. No clear guidelines exist for the management of PHPT during pregnancy, with observation and rehydration being the preferred initial options. The use of cinacalcet as well as curative surgical parathyroidectomy when Ca levels persist >11 in the second trimester have also been described. Our patient presented similarly, with severe pre-eclampsia needing urgent C-section, further complicated by persistent severe HCa. Early diagnosis of PHPT, along with treatment including cinacalcet improved her Ca. It is therefore important that PHPT be considered in patients presenting like ours, progressing to severe pre-eclampsia as early reduction of serum calcium may reduce morbidity and mortality. ReferencesMcCarthy, A., Howarth, S., Khoo, S., Hale, J., Oddy, S., Halsall, D., ... & Samyraju, M. (2019). Management of primary hyperparathyroidism in pregnancy: a case series. Endocrinology, diabetes & metabolism case reports, 2019(1).