scholarly journals Management of primary hyperparathyroidism in pregnancy: a case series

2019 ◽  
Vol 2019 ◽  
Author(s):  
Aisling McCarthy ◽  
Sophie Howarth ◽  
Serena Khoo ◽  
Julia Hale ◽  
Sue Oddy ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Case Series ◽  
Definitive Treatment ◽  
List Type ◽  
Second Trimester ◽  
Management Options ◽  
Neonatal Complications ◽  
Fetal Complications ◽  
In Pregnancy

Summary Primary hyperparathyroidism (PHPT) is characterised by the overproduction of parathyroid hormone (PTH) due to parathyroid hyperplasia, adenoma or carcinoma and results in hypercalcaemia and a raised or inappropriately normal PTH. Symptoms of hypercalcaemia occur in 20% of patients and include fatigue, nausea, constipation, depression, renal impairment and cardiac arrythmias. In the most severe cases, uraemia, coma or cardiac arrest can result. Primary hyperparathyroidism in pregnancy is rare, with a reported incidence of 1%. 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 a three to five-fold increased risk of miscarriage. There is a direct relationship between the degree of severity of hypercalcaemia and miscarriage risk, with miscarriage being more common in those patients with a serum calcium greater than 2.85 mmol/L. Neonatal complications include hypocalcemia. Herein, we present a case series of three women who were diagnosed with primary hyperparathyroidism in pregnancy. Case 1 was diagnosed with multiple endocrine neoplasia type 1 (MEN1) in pregnancy and required a bilateral neck exploration and subtotal parathyroidectomy in the second trimester of her pregnancy due to symptomatic severe hypercalcaemia. Both case 2 and case 3 were diagnosed with primary hyperparathyroidism due to a parathyroid adenoma and required a unilateral parathyroidectomy in the second trimester. This case series highlights the work-up and the tailored management approach to patients with primary hyperparathyroidism in pregnancy. Learning points: Primary hyperparathyroidism in pregnancy is associated with a high incidence of associated maternal fetal and neonatal complications directly proportionate to degree of maternal serum calcium levels. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism in pregnancy and was used in the management of all three cases in this series. It is recommended when serum calcium is persistently greater than 2.75 mmol/L and or for the management of maternal or fetal complications of hypercalcaemia. Surgical management, when necessary is ideally performed in the second trimester. Primary hyperparathyroidism is genetically determined in ~10% of cases, where the likelihood is increased in those under 40 years, where there is relevant family history and those with other related endocrinopathies. Genetic testing is a useful diagnostic adjunct and can guide treatment and management options for patients diagnosed with primary hyperparathyroidism in pregnancy, as described in case 1 in this series, who was diagnosed with MEN1 syndrome. Women of reproductive age with primary hyperparathyroidism need to be informed of the risks and complications associated with primary hyperparathyroidism in pregnancy and pregnancy should be deferred and or avoided until curative surgery has been performed and calcium levels have normalised.

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

2021 ◽  
Vol 10 (13) ◽  
pp. 2956
Author(s):  
Dalal S. Ali ◽  
Karel Dandurand ◽  
Aliya A. Khan
Keyword(s):  
Primary Hyperparathyroidism ◽  
Case Reports ◽  
Safety Data ◽  
Case Series ◽  
Close Monitoring ◽  
Management Options ◽  
Diagnosis And Management ◽  
Severe Hypercalcemia ◽  
Fetal Complications ◽  
In Pregnancy

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.

scholarly journals Primary Hyperparathyroidism in Pregnancy: A Two-Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
A. D. Herrera-Martínez ◽  
R. Bahamondes-Opazo ◽  
R. Palomares-Ortega ◽  
C. Muñoz-Jiménez ◽  
M. A. Gálvez-Moreno ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Early Diagnosis ◽  
Literature Review ◽  
Primary Hyperparathyroidism ◽  
Serum Levels ◽  
Second Trimester ◽  
Uncommon Disease ◽  
Fetal Complications ◽  
In Pregnancy

Primary hyperparathyroidism (PHPT) in pregnant women is an uncommon disease. It could be easily misdiagnosed because of physiologic changes during pregnancy; in some cases, patients could remain asymptomatic maintaining elevated calcium serum levels, and this situation represents a threat to the health of both mother and fetus. We present two cases of PHPT during pregnancy and their evolution after surgical treatment in the second trimester; there were no observed complications during pregnancy or delivery in our patients. Early diagnosis and medical/surgical treatment in PHPT are necessary for avoiding maternal and fetal complications which could not be predicted based on duration or severity of hypercalcemia. An appropriate management of PHPT during pregnancy is necessary for preserving the health of both the woman and the fetus.

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

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A783-A784
Author(s):  
Jason Lofters ◽  
Nia Flemming ◽  
Latoya Gayle ◽  
Ro-Kaye Simmonds ◽  
Oluwafeyi Adedoyin ◽  
...  
Keyword(s):  
Weight Gain ◽  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Case Reports ◽  
Case Series ◽  
Stable Condition ◽  
Fetal Lung ◽  
Gradual Improvement ◽  
Normal Urine ◽  
In Pregnancy

Abstract 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).

scholarly journals Primary hyperparathyroidism and Zollinger Ellison syndrome during pregnancy: a case report

2021 ◽  
Vol 2021 ◽  
Author(s):  
Dalal Ali ◽  
Patrick Divilly ◽  
Ruth Prichard ◽  
Dermot O’Toole ◽  
Donal O’Shea ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Unplanned Pregnancy ◽  
Case Series ◽  
Medical Attention ◽  
High Dose ◽  
List Type ◽  
Childbearing Age ◽  
Zollinger Ellison Syndrome ◽  
In Pregnancy

Summary Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited endocrine disorder with a high rate of penetrance. The incidence of MEN1 is 1/30,000 in the general population; however, it is quite rare for a patient to present for medical attention with MEN1 for the first time in pregnancy. Primary hyperparathyroidism (PHPT) is one of the most common features of MEN1. The incidence of PHPT occurring in pregnancy is 1%. Despite advances in the medical, surgical and obstetric care over the years, management of this condition during pregnancy may be challenging. It can be difficult to identify pregnant women with PHPT requiring intervention and to monitor safely. Hypercalcemia can result in significant maternal and fetal adverse outcomes including: miscarriage, intrauterine growth restriction, preterm delivery, neonatal hypocalcaemia, pre-eclampsia and maternal nephrolithiasis. Herein, we present a case study of a lady with a strong family history of MEN1, who was biochemically proven to have PHPT and evidence of Zollinger Ellison Syndrome (ZE) on endoscopy. This patient delayed her assisted pregnancy plans for in vitro fertilization (IVF) until completion of the MEN1 workup; nevertheless, she spontaneously achieved an unplanned pregnancy. As a result, she required intervention with parathyroidectomy in the second trimester of her pregnancy as her calcium level continued to rise. This case study highlights the workup, follow up and management of MEN1 presenting with PHPT and ZE in pregnancy. Learning points Women of childbearing age who are suspected to have a diagnosis of primary hyperparathyroidism ideally should have genetic testing and avoid pregnancy until definitive plans are in place. Zollinger Ellison syndrome in pregnancy means off-label use of high dose of proton pump inhibitors (PPI). Use of PPI in pregnancy is considered to be safe based on retrospective studies. Omeprazole, however, is FDA class C drug because of lack of large prospective studies or large case series during pregnancy. Calcium supplements in the form of calcium carbonate must be converted to calcium chloride by gastric acid in order to be absorbed, however, patients rendered achlorhydric as a result of PPI use will have impaired absorption of calcium. Therefore, use of calcium citrate might be considered a better option in this case.

PRIMARY HYPERPARATHYROIDISM DURING PREGNANCY: A CASE SERIES OF 8 PATIENTS

2019 ◽  
Vol 25 (11) ◽  
pp. 1127-1136 ◽  
Author(s):  
An Song ◽  
Wenbo Wang ◽  
Sixing Chen ◽  
Yabing Wang ◽  
Shuzhong Liu ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Gastrointestinal Tract ◽  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Pregnancy Outcomes ◽  
Clinical Manifestations ◽  
Case Series ◽  
Control Group ◽  
Neonatal Complications

Objective: Due to a lack of typical clinical manifestations and physiologic changes in calcium metabolism during pregnancy, primary hyperparathyroidism (PHPT) during pregnancy is commonly underdiagnosed, and treatment during this unique period presents a clinical challenge. Hence, the aim of the present study was to summarize the cases of 8 pregnant patients with PHPT who were treated at our center to provide better clinical insight into this condition. Methods: Our study comprised a retrospective analysis of 8 pregnant PHPT patients and a control group of 22 age-matched, nonpregnant PHPT patients during the same period. Clinical manifestations, biochemical indices, pathologic types, therapeutic strategies, and pregnancy outcomes were compiled, and 25 patients were screened for germline mutations in the MEN1, CDC73, and CaSR genes. Results: The most-common symptoms in the pregnancy group involved the gastrointestinal tract (GIT) in 7/8 cases (87.5%), followed by urinary system involvement (50%) and joint pain (50%). In contrast, GIT symptoms in the control group were significantly less common (31.82%; P = .012). There was a trend of more-severe elevation of serum parathyroid hormone levels in the control group compared to that in the pregnancy group ( P = .053). No differences were found in blood-ionized calcium, phosphate, or alkaline phosphatase levels between the two groups. In the pregnancy group, the serum albumin-corrected calcium level was reduced from 3.42 ± 0.66 mmol/L to 2.89 ± 0.46 mmol/L ( P = .025) after hydration and medical treatment. Six patients, three of whom were in the second trimester of pregnancy, underwent parathyroidectomy, and 3 patients were after childbirth or had induced labor. Postoperative serum calcium levels were reduced to within the normal range. Fetal/neonatal complications were observed in 4 of 5 patients who had not received surgical treatment during pregnancy. In addition, 2 of 5 pregnant PHPT patients were found to carry MEN1 mutations, whereas no mutations were detected in any of the 20 nonpregnant patients. Conclusion: In this case series of PHPT during pregnancy, the most-common complaint of GIT symptoms may be easily confused with pregnancy reactions, which might contribute to the under- or misdiagnosis of this clinical entity. Patients who did not receive surgical treatment during pregnancy had high incidences of fetal/neonatal complications and worse pregnancy outcomes. Abbreviations: CaSR = calcium-sensing receptor; CDC73 = cell division cycle 73; GIT = gastrointestinal tract; MEN = multiple endocrine neoplasia; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone; SCa = serum calcium

scholarly journals Curative resection of an aldosteronoma causing primary aldosteronism in the second trimester of pregnancy

2020 ◽  
Vol 2020 ◽  
Author(s):  
Skand Shekhar ◽  
Rasha Haykal ◽  
Crystal Kamilaris ◽  
Constantine A Stratakis ◽  
Fady Hannah-Shmouni
Keyword(s):  
Primary Aldosteronism ◽  
Secondary Hypertension ◽  
Uncontrolled Hypertension ◽  
List Type ◽  
Second Trimester ◽  
Unilateral Adrenalectomy ◽  
Fetal Complications ◽  
Common Etiology ◽  
History Of ◽  
In Pregnancy

Summary A 29-year-old primigravida woman with a known history of primary aldosteronism due to a right aldosteronoma presented with uncontrolled hypertension at 5 weeks of estimated gestation of a spontaneous pregnancy. Her hypertension was inadequately controlled with pharmacotherapy which lead to the consideration of surgical management for her primary aldosteronism. She underwent curative right unilateral adrenalectomy at 19 weeks of estimated gestational age. The procedure was uncomplicated, and her blood pressure normalized post-operatively. She did, however, have a preterm delivery by cesarean section due to intrauterine growth retardation with good neonatal outcome. She is normotensive to date. Learning points: Primary aldosteronism is the most common etiology of secondary hypertension with an estimated prevalence of 5–10% in the hypertensive population. It is important to recognize the subtypes of primary aldosteronism given that certain forms can be treated surgically. Hypertension in pregnancy is associated with significantly higher maternal and fetal complications. Data regarding the treatment of primary aldosteronism in pregnancy are limited. Adrenalectomy can be considered during the second trimester of pregnancy if medical therapy fails to adequately control hypertension from primary aldosteronism.

scholarly journals Primary Hyperparathyroidism in Pregnancy: Successful Parathyroidectomy during First Trimester

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Niranjan Tachamo ◽  
Bidhya Timilsina ◽  
Rashmi Dhital ◽  
Theresa Lynn ◽  
Vasudev Magaji ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Conservative Management ◽  
First Trimester ◽  
Second Trimester ◽  
Therapeutic Challenge ◽  
Fetal Complications ◽  
In Pregnancy

Primary hyperparathyroidism in pregnancy can result in significant maternal and fetal complications. When indicated, prompt parathyroidectomy in the early second trimester is considered the treatment of choice. Pregnant patients with primary hyperparathyroidism who have an indication for parathyroidectomy during the first trimester represent a therapeutic challenge. We present the case of a 32-year-old primigravida who presented with symptomatic hypercalcemia from her primary hyperparathyroidism. She remained symptomatic despite aggressive conservative management and underwent parathyroidectomy in her first trimester with excellent outcomes.

Primary hyperparathyroidism in pregnancy: a case series and literature review

2016 ◽  
Vol 32 (10) ◽  
pp. 783-786 ◽  
Author(s):  
Naile Gokkaya ◽  
Adem Gungor ◽  
Arzu Bilen ◽  
Habib Bilen ◽  
Darina Gviniashvili ◽  
...  
Keyword(s):  
Literature Review ◽  
Primary Hyperparathyroidism ◽  
Case Series ◽  
In Pregnancy

scholarly journals A rare case of hypercalcemia-induced pancreatitis in a first trimester pregnant woman

2018 ◽  
Vol 2018 ◽  
Author(s):  
Carine Ghassan Richa ◽  
Khadija Jamal Saad ◽  
Ali Khaled Chaaban ◽  
Mohamad Souheil El Rawas
Keyword(s):  
Acute Pancreatitis ◽  
Pregnant Woman ◽  
Primary Hyperparathyroidism ◽  
Rare Case ◽  
First Trimester ◽  
List Type ◽  
Second Trimester ◽  
Adequate Treatment ◽  
Severe Hypercalcemia ◽  
First Trimester Of Pregnancy

Summary The objective of the study is to report a case of acute pancreatitis secondary to hypercalcemia induced by primary hyperparathyroidism in a pregnant woman at the end of the first trimester. The case included a 32-year-old woman who was diagnosed with acute pancreatitis and severe hypercalcemia refractory to many regimens of medical therapy in the first trimester of pregnancy. She was successfully treated with parathyroidectomy in the early second trimester with complete resolution of hypercalcemia and pancreatitis. Neonatal course was unremarkable. To our best knowledge, this is a rare case when primary hyperparathyroidism and its complications are diagnosed in the first trimester of pregnancy. In conclusion, primary hyperparathyroidism is a rare life-threatening condition to the fetus and mother especially when associated with complications such as pancreatitis. Early therapeutic intervention is important to reduce the morbidity and mortality. Parathyroidectomy performed in the second trimester can be the only solution. Learning points: Learning how to make diagnosis of primary hyperparathyroidism in a woman during the first trimester of pregnancy. Understanding the complications of hypercalcemia and be aware of the high mortality and sequelae in both fetus and mother. Providing the adequate treatment in such complicated cases with coordinated care between endocrinologists and obstetricians to ensure optimal outcomes.

scholarly journals Primary hyperparathyroidism in pregnancy: a case series

2015 ◽  
Author(s):  
Naile Gokkaya ◽  
Adem Gungor ◽  
Arzu Bilen ◽  
Habib Bilen
Keyword(s):  
Primary Hyperparathyroidism ◽  
Case Series ◽  
In Pregnancy
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