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Primary hyperparathyroidism in pregnancy

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Abstract

Primary hyperparathyroidism (PHPT) is rarely diagnosed during pregnancy but is associated with significant maternal and fetal morbidity and mortality. Information on appropriate management is limited. We reviewed the medical literature through December 2012 for key articles on PHPT during pregnancy, focusing on large series. Clinical knowledge in this area is restricted to isolated case reports and a few retrospective studies. Diagnosis can be difficult, owing to the non-specific nature of signs and symptoms of hypercalcemia during pregnancy. Pregnant women with a calcium level over 2.85 mmol/L (11.4 mg/dL) and prior pregnancy loss are at a particularly high risk of maternal complications (hypercalcemic crisis, nephrolithiasis, pancreatitis, etc.) and fetal loss. Around one-half of neonates born to mothers with untreated PHPT have hypocalcemia and tetany. Algorithms proposed for the management of the pregnant woman with PHPT are not evidence based, reflecting the paucity of data. Treatment should thus be individually tailored. Gestational age and the severity of hypercalcemia should be taken into account when assessing the risk–benefit balance of a conservative approach (hyperhydration and vitamin D supplementation) versus parathyroid surgery. Current evidence supports parathyroidectomy as the main treatment, performed preferably during the second trimester, when the serum calcium is above 2.75 mmol/L (11 mg/dL). In the patients with mild forms of PHPT, which are nowadays the most frequent, a conservative management is generally preferred.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Service d’Endocrinologie et des Maladies de la Reproduction, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, 94275, Le Kremlin Bicêtre, France

    Gonzalo Diaz-Soto, Peter Kamenicky & Philippe Chanson

  2. Service d’Endocrinologie Pédiatrique,Centre de Référence des Maladies Rares du Métabolisme Phospho-Calcique, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, 94275, Le Kremlin Bicêtre, France

    Agnès Linglart

  3. Service de Gynécologie-Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, 94275, Le Kremlin Bicêtre, France

    Marie-Victoire Sénat

  4. Servicio de Endocrinologia, Hospital Clinico Universitario de Valladolid, IEN-University of Valladolid, Valladolid, Spain

    Gonzalo Diaz-Soto

  5. Faculté de Médecine Paris-Sud, Univ Paris-Sud, UMR-S693, 94276, Le Kremlin Bicêtre, France

    Agnès Linglart, Marie-Victoire Sénat, Peter Kamenicky & Philippe Chanson

  6. Institut National de la Santé et de la Recherche Médicale U986, 94276, Le Kremlin Bicêtre, France

    Agnès Linglart

  7. Institut National de la Santé et de la Recherche Médicale U693, 94276, Le Kremlin Bicêtre, France

    Peter Kamenicky & Philippe Chanson

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  1. Gonzalo Diaz-Soto
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  2. Agnès Linglart
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Correspondence to Philippe Chanson.

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Diaz-Soto, G., Linglart, A., Sénat, MV. et al. Primary hyperparathyroidism in pregnancy. Endocrine 44, 591–597 (2013). https://doi.org/10.1007/s12020-013-9980-4

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