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Primary hyperparathyroidism in pregnancy: observations from the Indian PHPT registry

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Abstract

Purpose

To present the data on primary hyperparathyroidism (PHPT) in pregnancy from India obtained from a large database maintained over 15 years.

Methods

We retrieved data of all women with gestational PHPT from the Indian PHPT registry between July 2005 and January 2020, and compared their clinical, biochemical, and other characteristics with age-matched non-pregnant women with PHPT.

Results

Out of 386 women, eight had gestational PHPT (2.1%). The common presenting manifestations were acute pancreatitis (50%) and renal stone disease (50%); two were asymptomatic. Five women (62.5%) had a history of prior miscarriages. Seven patients (88%) had preeclampsia during the present gestation. Serum calcium and intact parathyroid hormone (iPTH) were not statistically different from the age-matched non-pregnant PHPT group. Six patients with mild-to-moderate hypercalcemia were medically managed with hydration with/without cinacalcet while one patient underwent percutaneous ethanol ablation of the parathyroid adenoma; none underwent surgery during pregnancy. Mean serum calcium maintained from treatment initiation till delivery was 10.5 ± 0.4 mg/dl. One patient had spontaneous preterm delivery at 36 weeks; the remaining patients had normal vaginal delivery at term. None had severe preeclampsia/eclampsia. Fetal outcomes included low birth weight in three newborns (37.5%); two of them had hypocalcemic seizures.

Conclusion

The prevalence of gestational PHPT was 2.1% in this largest Indian PHPT cohort, which is higher than that reported from the West (< 1%). Gestational PHPT can lead to preeclampsia and miscarriage. Pregnant PHPT patients with mild-to-moderate hypercalcemia can be managed with hydration/cinacalcet; however, long-term safety data and large-scale randomized controlled trials are required.

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Data availability

Anonymous data sheets will be made available on reasonable request to the corresponding author.

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Authors and Affiliations

  1. Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    R. Pal, S. K. Bhadada, N. Gupta, A. Aggarwal, K. V. Raviteja, G. Kaur, S. M. Arvindbhai & R. Walia

  2. Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    A. Behera

  3. Department of Gynecology and Obstetrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    N. Aggarwal

  4. Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    U. N. Saikia

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  1. R. Pal
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Contributions

RP is the primary author. SKB is the corresponding author, had conceptualized and edited the manuscript. NG, AA, KVR, GK and SMA had helped in data collection. AB had been the operating surgeon. NA had been the treating gynecologist. UNS had been the histopathologist. RW had edited the manuscript. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to S. K. Bhadada.

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The authors declare that they have no conflict of interest.

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Obtained from Institute Ethics Committee, PGIMER, Chandigarh, India.

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No animals were used for this study.

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Formal consent was obtained from all the participants.

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Pal, R., Bhadada, S.K., Gupta, N. et al. Primary hyperparathyroidism in pregnancy: observations from the Indian PHPT registry. J Endocrinol Invest 44, 1425–1435 (2021). https://doi.org/10.1007/s40618-020-01441-z

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