scholarly journals Parathyroid Disease in Pregnancy and Lactation: A Narrative Review of the Literature

Biomedicines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 475
Author(s):  
Elena Tsourdi ◽  
Athanasios D. Anastasilakis
Keyword(s):  
Bone Loss ◽  
Primary Hyperparathyroidism ◽  
Calcium Homeostasis ◽  
Calcium Absorption ◽  
Treatment Strategies ◽  
Review Of The Literature ◽  
Fetal Health ◽  
Pregnancy And Lactation ◽  
Parathyroid Disease ◽  
In Pregnancy

Pregnancy and lactation are characterized by sophisticated adaptations of calcium homeostasis, aiming to meet fetal, neonatal, and maternal calcium requirements. Pregnancy is primarily characterized by an enhancement of intestinal calcium absorption, whereas during lactation additional calcium is obtained through resorption from the maternal skeleton, a process which leads to bone loss but is reversible following weaning. These maternal adaptations during pregnancy and lactation may influence or confound the presentation, diagnosis, and management of parathyroid disorders such as primary hyperparathyroidism or hypoparathyroidism. Parathyroid diseases are uncommon in these settings but can be severe when they occur and may affect both maternal and fetal health. This review aims to delineate the changes in calcium physiology that occur with pregnancy and lactation, describe the disorders of calcium and parathyroid physiology that can occur, and outline treatment strategies for these diseases in the above settings.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management

2019 ◽  
Vol 180 (2) ◽  
pp. R37-R44 ◽  
Author(s):  
Aliya A Khan ◽  
Bart Clarke ◽  
Lars Rejnmark ◽  
Maria Luisa Brandi
Keyword(s):  
Calcium Homeostasis ◽  
Best Practice ◽  
Calcium Absorption ◽  
Normal Serum ◽  
Evidence Based ◽  
Close Monitoring ◽  
Optimal Care ◽  
Uncomplicated Pregnancy ◽  
Increased Risk ◽  
In Pregnancy

Purpose Review calcium homeostasis in pregnancy and provide evidence-based best practice recommendations for the management of hypoparathyroidism in pregnancy. Methods We searched MEDLINE, EMBASE and Cochrane databases from January 2000 to April 1, 2018. A total of 65 articles were included in the final review. Conclusions During pregnancy, calcitriol levels increase by two- to—three-fold resulting in enhanced intestinal calcium absorption. The renal filtered calcium load increases leading to hypercalciuria. PTHrP production by the placenta and breasts increases by three-fold, and this may lower the doses of calcium and calcitriol required during pregnancy in mothers with hypoparathyroidism. The literature however describes a wide variation in the required doses of calcium and calcitriol during pregnancy in hypoparathyroid mothers, with some women requiring higher doses of calcitriol, whereas others require lower doses. Close monitoring is necessary as hypercalcemia in the mother may suppress the fetal parathyroid gland development. Also hypocalcemia in the mother is harmful as it may result in secondary hyperparathyroidism in the fetus. This may be associated with demineralization of the fetal skeleton and the development of intrauterine fractures. Inadequate treatment of hypoparathyroidism may also result in uterine contractions and an increased risk of miscarriage. Treatment targets during pregnancy are to maintain a low normal serum calcium. Calcium, calcitriol and vitamin D supplements are safe during pregnancy. Close monitoring of the mother with a multidisciplinary team is advised for optimal care. If calcium homeostasis is well controlled during pregnancy, most women with hypoparathyroidism have an uncomplicated pregnancy and give birth to healthy babies.

Calcium homeostasis in pregnancy and lactation

1993 ◽  
Vol 72 (7) ◽  
pp. 509-513 ◽  
Author(s):  
Kjell Haram ◽  
Hrafnkell Thordarson ◽  
Tor Hervig
Keyword(s):  
Calcium Homeostasis ◽  
Pregnancy And Lactation ◽  
In Pregnancy

scholarly journals Primary hyperparathyroidism in pregnancy treated with cinacalcet: a case report and review of the literature

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Lara Vera ◽  
Silvia Oddo ◽  
Natascia Di Iorgi ◽  
Giorgio Bentivoglio ◽  
Massimo Giusti
Keyword(s):  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Review Of The Literature ◽  
In Pregnancy

PLASMA 1,25-DIHYDROXYVITAMIN D LEVELS IN PREGNANCY AND LACTATION

1979 ◽  
Vol 92 (2) ◽  
pp. 330-335 ◽  
Author(s):  
Bjarne Lund ◽  
Anders Selnes
Keyword(s):  
Calcium Absorption ◽  
Plasma Concentrations ◽  
Serum Prolactin ◽  
Serum Parathyroid Hormone ◽  
Human Pregnancy ◽  
Dihydroxyvitamin D ◽  
1,25 Dihydroxyvitamin D ◽  
Causative Relationship ◽  
Pregnancy And Lactation ◽  
In Pregnancy

ABSTRACT Plasma concentrations of 1,25-dihydroxyvitamin D (1,25–(OH)2D), serum prolactin and serum parathyroid hormone (PTH) were followed during pregnancy and lactation in 16 women. High 1,25–(OH)2D was demonstrated in human pregnancy and lactation. A causative relationship between 1,25–(OH)2D and prolactin is discussed and a possible explanation of the mechanism of the augmented calcium absorption in human pregnancy and lactation is suggested.

scholarly journals Multidisciplinary team efforts to improve the pregnancy outcome of pregnancy complicated with primary hyperparathyroidism: case series from a single hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hai-ning Jiao ◽  
Li-hao Sun ◽  
Yan Liu ◽  
Jian-qiao Zhou ◽  
Xi Chen ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multidisciplinary Team ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Case Series ◽  
Retrospective Case ◽  
Infant Outcomes ◽  
Management Algorithm ◽  
Preoperative Serum ◽  
In Pregnancy

Abstract Background There is no consensus or management algorithm for primary hyperparathyroidism (PHPT) in pregnancy. Methods This study comprises a retrospective case series. From August 2014 to December 2020, 9 cases of PHPT in pregnancy were diagnosed by a multidisciplinary team (MDT) consultation center of obstetrics in our hospital. Their clinical manifestations, treatment strategies, and maternal and infant outcomes were analyzed. Results The median onset age of the patients was 32 (25 ~ 38) years. PHPT was diagnosed in two cases before pregnancy, in six cases during pregnancy and in one case postpartum. The main clinical manifestations were nausea, vomiting, and other nonspecific symptoms, with anemia as the most common maternal complication. Hypercalcemia crisis was developed in one case. The median levels of preoperative serum calcium and parathyroid hormone (PTH) were 3.08 (2.77 ~ 4.21) mmol/L and 300.40 (108.80 ~ 2603.60) pg/ml, respectively. The parathyroid ultrasonography tests were positive in eight cases and negative in one patient who had an ectopic lesion localized by 99mTc-MIBI. Parathyroidectomy was conducted in 7 cases during the 2nd trimester, including 2 patients diagnosed before pregnancy who refused surgery, 1 patient during the 1st trimester, and 1 patient postpartum, with a significant reduction in serum concentrations of calcium and PTH. A management algorithm was developed. Conclusion This case series suggests that pregnant women with PHPT should be managed by MDT according to the algorithm. If PHPT is confirmed in fertile women before pregnancy, parathyroidectomy should be strongly suggested and performed. If PHPT is diagnosed during pregnancy, even in its mild form, surgical treatment, optimally during the 2nd trimester, is effective and safe for pregnancy and neonatal outcome.

scholarly journals Phyllodes Tumor of the Breast during Pregnancy and Lactation; A Systematic Review

2020 ◽  
Vol 23 (7) ◽  
pp. 488-497
Author(s):  
Sadaf Alipour ◽  
Amirhossein Eskandari ◽  
Fatimah Mat Johar ◽  
Shinji Furuya
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Phyllodes Tumor ◽  
Review Of The Literature ◽  
Ovid Medline ◽  
Large Size ◽  
Rapid Enlargement ◽  
Pregnancy And Lactation ◽  
The Mean ◽  
In Pregnancy

Background: Phyllodes tumor (PT) is a rare tumor of the breast, which may occur during pregnancy or lactation. Several studies have reviewed and discussed PT occurring in pregnancy, gathering up to 14 patients. We performed a thorough systematic review of the literature in an attempt to find all reported cases, and identify their common characteristics. Methods: We searched Google scholar, PubMed, Ovid Medline, Scopus and ClinicalTrials.gov with several relevant combinations of keywords, looking for texts or abstracts without any date or language limitations, but using only English keywords. The existing literature only consisted of case reports and series; therefore any paper including one or several cases of PT presenting during pregnancy or breastfeeding was recognized as eligible. Articles with vague description of the tumor which made the diagnosis uncertain, and those lacking data about the tumor and management data were excluded. We contacted authors for more details in cases with incomplete information. Results: After excluding those with very deficient data, we included 37 studies, counting 43 cases. The mean age of the patients was 31 years (21-43 years). Some features were different from usual PT: bilaterality (16.2%), large size (14.2 ± 8.6 cm), rapid enlargement (79.5%), and rate of malignancy (60.5%). Conclusion: Our findings show high rates of bilaterality, large size, rapid growth, and malignant pathology in the reported gestational PTs.

Calcium in pregnancy and breastfeeding

2015 ◽  
Author(s):  
Sir Peter Gluckman ◽  
Mark Hanson ◽  
Chong Yap Seng ◽  
Anne Bardsley
Keyword(s):  
Vitamin D ◽  
Bone Loss ◽  
Bone Growth ◽  
Calcium Absorption ◽  
The Body ◽  
Calcium Stores ◽  
Third Trimester ◽  
Pregnant Adolescents ◽  
The Third ◽  
In Pregnancy

Most calcium in the body is present in the skeleton, where it serves a structural role and also as a reservoir for use in other tissues. During pregnancy, calcium is accumulated in the fetal skeleton, mostly during the third trimester when bone growth is at its peak. Although this increases the demand on maternal bone stores, the calcium transfer to the fetus is balanced by increased intestinal calcium absorption in the mother, mediated by compensatory changes in vitamin D synthesis and endogenous hormone levels. Bone loss is minimized if calcium intake is maintained at 1,000#amp;#x2013;1,200 mg/day during pregnancy. This intake level builds up calcium stores in early pregnancy for increased fetal transfer in the third trimester. Additional dietary calcium is usually not required if pre-pregnancy intake is adequate, although pregnant adolescents and women carrying multiple fetuses may require supplementation.

Multidisciplinary Team Efforts to Improve the Pregnancy Outcome of Pregnancy Complicated with Primary Hyperparathyroidism: Case Series from a Single Hospital

2021 ◽  
Author(s):  
Hai-ning Jiao ◽  
Li-hao Sun ◽  
Yan Liu ◽  
Jian-qiao Zhou ◽  
Xi Chen ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multidisciplinary Team ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Case Series ◽  
Retrospective Case ◽  
Infant Outcomes ◽  
Management Algorithm ◽  
Preoperative Serum ◽  
In Pregnancy

Abstract Background There is no consensus or management algorithm for primary hyperparathyroidism (PHPT) in pregnancy༎ Methods This is a retrospective case series. From August 2014 to December 2020, 9 cases of PHPT in pregnancy were diagnosed by multidisciplinary team (MDT) consultation center of obstetrics in our hospital. Their clinical manifestations, treatment strategies, maternal and infant outcomes were analyzed. Results The median onset age of the patients was 32 (25 ~ 38) years. PHPT was diagnosed in two cases before pregnancy, six cases during pregnancy and one case postpartum. The main clinical manifestations were nausea, vomiting, and other nonspecific symptoms, together with anemia as the most common maternal complication. Hypercalcemia crisis was developed in one case. The median levels of preoperative serum calcium and parathyroid hormone (PTH) were 3.08 (2.77 ~ 4.21) mmol/L and 300.40 (108.80 ~ 2603.60)pg/ml, respectively. The parathyroid ultrasonography tests were positive in eight cases, and negative in one case who had an ectopic lesion localized by 99mTc-MIBI. Parathyroidectomy was conducted in 7 cases during 2nd trimester including 2 cases diagnosed before pregnancy but refused operation at that time, 1 case during 1st trimester ,and 1 after postpartum, with significant reduction of serum concentrations of calcium and PTH. A management algorithm was developed. Conclusion This case series suggest that pregnant women with PHPT should be managed by MDT according to algorithm. If PHPT is confirmed in fertile women before pregnancy, parathyroidectomy should be strongly suggested and performed at that time. If PHPT is diagnosed during pregnancy, even in its mild form, surgical treatment, optimally during 2nd trimester, is effective and safe for pregnancy and neonate outcome.

THIOURACIL TREATMENT IN PREGNANCY AND LACTATION IN THE DOG

1962 ◽  
Vol 40 (3) ◽  
pp. 430-440 ◽  
Author(s):  
K. E. Arosenius ◽  
H. Derblom ◽  
G. Nylander
Keyword(s):  
Thyroid Gland ◽  
List Type ◽  
Histological Changes ◽  
Morphological Effect ◽  
Iodine Metabolism ◽  
Pregnancy And Lactation ◽  
In Pregnancy

ABSTRACT The offspring of bitches treated with thiouracil during pregnancy and lactation were studied with regard to certain aspects of iodine metabolism and also to the morphological effect on the thyroid gland, as compared with controls of the same age and weight. At the age of six months, when the dogs were virtually fully grown, the thyroid gland still exhibited the effects of the thiouracil treatment of the mothers as manifested by an increased uptake of 131I, enlargement, and histological changes of a hyperplastic type. The significance of these deviations from normal iodine metabolism and morphology is discussed with particular reference to the dangers of thiouracil medication during pregnancy.

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