open access
Primary hyperparathyroidism in pregnancy — a review of literature
Affiliations- Department of Endocrinology, Metabolism and Internal Medicine, University of Medical Sciences, Poznan, Poland
open access
Abstract
Hyperparathyroidism during pregnancy is diagnosed in 0.5–1.4% women and poses a serious challenge. Symptoms of primary hyperparathyroidism (PHP), namely fatigue, lethargy and proximal muscle weakness, are unspecific and could be mistaken as complaints naturally present during pregnancy. Thus, diagnosis is usually delayed. Moreover, the complications of PHP are very common. They occur in 67% of mothers and even in up to 80% of progeny. Appropriate management is a matter of debate. According to clinical symptoms, biochemical evaluation and trimester of pregnancy an operation or conservative management should be introduced. The recognition and understanding of the illness is therefore vital. Due to the lack of unequivocal guidelines concerning pregnancy and PHP, in this review we will analyze recent findings to facilitate proper proceedings.
Abstract
Hyperparathyroidism during pregnancy is diagnosed in 0.5–1.4% women and poses a serious challenge. Symptoms of primary hyperparathyroidism (PHP), namely fatigue, lethargy and proximal muscle weakness, are unspecific and could be mistaken as complaints naturally present during pregnancy. Thus, diagnosis is usually delayed. Moreover, the complications of PHP are very common. They occur in 67% of mothers and even in up to 80% of progeny. Appropriate management is a matter of debate. According to clinical symptoms, biochemical evaluation and trimester of pregnancy an operation or conservative management should be introduced. The recognition and understanding of the illness is therefore vital. Due to the lack of unequivocal guidelines concerning pregnancy and PHP, in this review we will analyze recent findings to facilitate proper proceedings.
Keywords
hypercalcemia, pregnancy, primary hyperparathyroidism, miscarriage
About this articleTitle
Primary hyperparathyroidism in pregnancy — a review of literature
Journal
Issue
Article type
Review paper
Pages
270-275
Published online
2017-05-31
Page views
3206
Article views/downloads
3552
DOI
Pubmed
Bibliographic record
Ginekol Pol 2017;88(5):270-275.
Keywords
hypercalcemia
pregnancy
primary hyperparathyroidism
miscarriage
Authors
Hanna Komarowska
Barbara Bromińska
Bartosz Luftmann
Marek Ruchała
References (35)- McMullen TPW, Learoyd DL, Williams DC, et al. Hyperparathyroidism in pregnancy: options for localization and surgical therapy. World J Surg. 2010; 34(8): 1811–1816.
- Lee CC, Chao AS, Chang YL, et al. Acute pancreatitis secondary to primary hyperparathyroidism in a postpartum patient: a case report and literature review. Taiwan J Obstet Gynecol. 2014; 53(2): 252–255.
- Breslau NA, Zerwekh JE. Relationship of estrogen and pregnancy to calcium homeostasis in pseudohypoparathyroidism. J Clin Endocrinol Metab. 1986; 62(1): 45–51.
- Kort KC, Schiller HJ, Numann PJ. Hyperparathyroidism and pregnancy. Am J Surg. 1999; 177(1): 66–68.
- Ip P. Neonatal convulsion revealing maternal hyperparathyroidism: an unusual case of late neonatal hypoparathyroidism. Arch Gynecol Obstet. 2003; 268(3): 227–229.
- Hession P, Walsh J, Gaffney G. Two cases of primary hyperparathyroidism in pregnancy. BMJ Case Rep. 2014; 2014.
- Scholl TO, Chen X, Stein TP. Maternal calcium metabolic stress and fetal growth. Am J Clin Nutr. 2014; 99(4): 918–925.
- Salles JP. Bone metabolism during pregnancy. Ann Endocrinol (Paris). 2016; 77(2): 163–168.
- Kovacs CS, Kronenberg HM. Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Endocr Rev. 1997; 18(6): 832–872.
- Eller-Vainicher C, Ossola MW, Beck-Peccoz P, et al. PTHrP-associated hypercalcemia of pregnancy resolved after delivery: a case report. Eur J Endocrinol. 2012; 166(4): 753–756.
- Lengelé B, Hamoir M. Anatomy and embryology of the parathyroid glands. Acta Otorhinolaryngol Belg. 2001; 55(2): 89–93.
- Kovacs CS. Calcium, phosphorus, and bone metabolism in the fetus and newborn. Early Hum Dev. 2015; 91(11): 623–628.
- Kovacs CS. Bone development and mineral homeostasis in the fetus and neonate: roles of the calciotropic and phosphotropic hormones. Physiol Rev. 2014; 94(4): 1143–1218.
- Cox LA. The biology of bone maturation and ageing. Acta Paediatr Suppl. 1997; 423: 107–108.
- Hultin H, Hellman P, Lundgren E, et al. Association of parathyroid adenoma and pregnancy with preeclampsia. J Clin Endocrinol Metab. 2009; 94(9): 3394–3399.
- Norman J, Politz D, Politz L. Hyperparathyroidism during pregnancy and the effect of rising calcium on pregnancy loss: a call for earlier intervention. Clin Endocrinol (Oxf). 2009; 71(1): 104–109.
- Hirsch D, Kopel V, Nadler V, et al. Pregnancy outcomes in women with primary hyperparathyroidism. J Clin Endocrinol Metab. 2015; 100(5): 2115–2122.
- Rutkowska J, Bandurska-Stankiewicz E, Matuszewski W, et al. Primary hyperparathyroidism in pregnancy — a diagnostic and therapeutic challenge. Endokrynol Pol. 2015; 66(3): 270–274.
- Abood A, Vestergaard P. Pregnancy outcomes in women with primary hyperparathyroidism. Eur J Endocrinol. 2014; 171(1): 69–76.
- Som M, Stroup JS. Primary hyperparathyroidism and pregnancy. Proc (Bayl Univ Med Cent). 2011; 24(3): 220–223.
- Malekar-Raikar S, Sinnott BP. Primary hyperparathyroidism in pregnancy-a rare cause of life-threatening hypercalcemia: case report and literature review. Case Rep Endocrinol. 2011; 2011: 520516.
- Dochez V, Ducarme G. Primary hyperparathyroidism during pregnancy. Arch Gynecol Obstet. 2015; 291(2): 259–263.
- Pattou F, Huglo D, Proye C. Radionuclide scanning in parathyroid diseases. Br J Surg. 1998; 85(12): 1605–1616.
- Agarwal AM, Bentz JS, Hungerford R, et al. Parathyroid fine-needle aspiration cytology in the evaluation of parathyroid adenoma: cytologic findings from 53 patients. Diagn Cytopathol. 2009; 37(6): 407–410.
- Abraham D, Sharma PK, Bentz J, et al. Utility of ultrasound-guided fine-needle aspiration of parathyroid adenomas for localization before minimally invasive parathyroidectomy. Endocr Pract. 2007; 13(4): 333–337.
- Stathopoulos IP, Liakou CG, Katsalira A, et al. The use of bisphosphonates in women prior to or during pregnancy and lactation. Hormones (Athens). 2011; 10(4): 280–291.
- Losada I, Sartori L, Di Gianantonio E, et al. Bisphosphonates in patients with autoimmune rheumatic diseases: Can they be used in women of childbearing age? Autoimmun Rev. 2010; 9(8): 547–552.
- Gerin M, Jambon G, Fouque-Aubert A, et al. Neonatal transient hypophosphatemic hypercalciuric rickets in dizygous twins: A role for maternal alendronate therapy before pregnancy or antireflux medications? Arch Pediatr. 2016; 23(9): 957–962.
- Horjus C, Groot I, Telting D, et al. Cinacalcet for hyperparathyroidism in pregnancy and puerperium. J Pediatr Endocrinol Metab. 2009; 22(8): 741–749.
- Rey E, Jacob CE, Koolian M, et al. Hypercalcemia in pregnancy - a multifaceted challenge: case reports and literature review. Clin Case Rep. 2016; 4(10): 1001–1008.
- Nadarasa K, Bailey M, Chahal H, et al. The use of cinacalcet in pregnancy to treat a complex case of parathyroid carcinoma. Endocrinol Diabetes Metab Case Rep. 2014; 2014: 140056.
- Diaz-Soto G, Linglart A, Sénat MV, et al. Primary hyperparathyroidism in pregnancy. Endocrine. 2013; 44(3): 591–597.
- Kelly TR. Primary hyperparathyroidism during pregnancy. Surgery. 1991; 110(6): 1028–33; discussion 1033.
- Pothiwala P, Levine SN. Parathyroid surgery in pregnancy: review of the literature and localization by aspiration for parathyroid hormone levels. J Perinatol. 2009; 29(12): 779–784.
- Walker A, Fraile JJ, Hubbard JG. Parathyroidectomy in pregnancy - a single centre experience with review of evidence and proposal for treatment algorithim. Gland Surg. 2014; 3(3): 158–64.
