Primary Hyperparathyroidism during Pregnancy

Two Tales with Different Outcomes

Authors

DOI:

https://doi.org/10.15605/jafes.039.01.17

Keywords:

endocrine disorders in pregnancy, primary hyperparathyroidism, pregnancy, hypercalcaemia

Abstract

Primary hyperparathyroidism (PHPT) is rare in pregnancy. This condition is challenging to diagnose and manage due to the limited diagnostic and therapeutic options that are safe during pregnancy. If not diagnosed and managed in a timely manner, serious maternal and foetal complications may occur. We report two cases, one with surgical intervention and one without, to show the importance of timely surgical intervention and discuss the challenges in the management of PHPT in pregnancy.

Downloads

Download data is not yet available.

Author Biographies

Yoon Doong Loh, Hospital Sultanah Nur Zahirah

Endocrinology Unit, Department of Internal Medicine, Hospital Sultanah Nur Zahirah, Ministry of Health, Malaysia

Masliza Hanuni Mohd Ali, Hospital Sultanah Nur Zahirah

Endocrinologist, Endocrinology Unit, Department of Internal Medicine, Hospital Sultanah Nur Zahirah, Ministry of Health, Malaysia

References

Kort KC, Schiller HJ, Numann PJ. Hyperparathyroidism and pregnancy. Am J Surg. 1999;177(1):66-8. https://pubmed.ncbi.nlm.nih.gov/10037311. https://doi.org/10.1016/s0002-9610(98)00302-x.

Heath H 3rd, Hodgson SF, Kennedy MA. Primary hyperparathyroidism. Incidence, morbidity, and potential economic impact in a community. N Engl J Med. 1980;302(4):189-93. https://pubmed.ncbi.nlm.nih.gov/7350459. https://doi.org/10.1056/NEJM198001243020402.

Shifrin A. Advances in diagnosis and management of primary hyperparathyroidism during pregnancy. Advances in treatment and management in surgical endocrinology. Elsevier Inc.; 2019.

Bollerslev J, Rejnmark L, Zahn A, et al. European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: Recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021). Eur J Endocrinol. 2022;186(2):R33-63. https://pubmed.ncbi.nlm.nih.gov/34863037. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8789028. https://doi.org/10.1530/EJE-21-1044.

Bollerslev J, Marcocci C, Sosa M, Nordenström J, Bouillon R, Mosekilde L. Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism. Eur J Endocrinol. 2011;165(6):851-64. https://pubmed.ncbi.nlm.nih.gov/21964961. https://doi.org/10.1530/EJE-11-0589.

Hassan-Smith ZK, Criseno S, Gittoes NJL. Mild primary hyperparathyroidism—to treat or not to treat? Br Med Bull. 2019;129(1):53-67. https://pubmed.ncbi.nlm.nih.gov/30576424. https://doi.org/10.1093/bmb/ldy042.

Bilezikian JP, Khan AA, Potts JT. Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the third international workshop. J Clin Endocrinol Metab. 2009;94(2):335–9. https://pubmed.ncbi.nlm.nih.gov/19193908. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214274. https://doi.org/10.1210/jc.2014-1413.

Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011;253(3):585-91. https://pubmed.ncbi.nlm.nih.gov/21183844. https://doi.org/10.1097/SLA.0b013e318208fed9.

Horjus C, Groot I, Telting D, et al. Cinacalcet for hyperparathyroidism in pregnancy and puerperium. J Pediatr Endocrinol Metab. 2009;22(8):741-9. https://pubmed.ncbi.nlm.nih.gov/19845125. https://doi.org/10.1515/jpem.2009.22.8.741.

Vera L, Oddo S, Di Iorgi N, Bentivoglio G, Giusti M. Primary hyperparathyroidism in pregnancy treated with cinacalcet: A case report and review of the literature. J Med Case Rep. 2016;10(1):361. https://pubmed.ncbi.nlm.nih.gov/27998296. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175373. https://doi.org/10.1186/s13256-016-1093-2.

Arshad MF, Arambewela MH, Bennet WM, Sterrenburg M, Balasubramanian SP. Primary hyperparathyroidism in pregnancy: Experience of a tertiary centre. Surg Today. 2023;53(4):470-5. https://pubmed.ncbi.nlm.nih.gov/36107253. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10042935. https://doi.org/10.1007/s00595-022-02583-8.

Rey E, Jacob C-E, Koolian M, Morin F. Hypercalcemia in pregnancy – a multifaceted challenge: Case reports and literature review. Clin Case Rep. 2016;4(10):1001-8. https://pubmed.ncbi.nlm.nih.gov/27761256. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054480. https://doi.org/10.1002/ccr3.646.

Joint Formulary Committee. Calcitonin (salmon). British National Formulary. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; [cited 2023 Feb 21]. https://bnf.nice.org.uk/drugs/calcitonin-salmon/.

Djokanovic N, Klieger-Grossmann C, Koren G. Does treatment with bisphosphonates endanger the human pregnancy? J Obstet Gynaecol Can. 2008;30(12):1146-8. https://pubmed.ncbi.nlm.nih.gov/19175968. https://doi.org/10.1016/S1701-2163(16)34026-9.

Patlas N, Golomb G, Yaffe P, Pinto T, Breuer E, Ornoy A. Transplacental effects of bisphosphonates on fetal skeletal ossification and mineralization in rats. Teratology. 1999;60(2):68-73. https://pubmed.ncbi.nlm.nih.gov/10440778. https://doi.org/10.1002/(SICI)1096-9926(199908)60:2<68::AID-TERA10>3.0.CO;2-H.

DiMarco AN, Meeran K, Christakis I, et al. Seventeen cases of primary hyperparathyroidism in pregnancy: A call for management guidelines. J Endocr Soc. 2019;3(5):1009–21. https://pubmed.ncbi.nlm.nih.gov/31065618. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497920. https://doi.org/10.1210/js.2018-00340.

Hui E, Osakwe O, Teoh TG, Tolley N, Robinson S. Three case reports of maternal primary hyperparathyroidism in each trimester and a review of optimal management in pregnancy. Obstet Med. 2010;3(1):33–7. https://pubmed.ncbi.nlm.nih.gov/27582838. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989765. https://doi.org/10.1258/om.2009.090040.

Schnatz PF, Thaxton S. Parathyroidectomy in the third trimester of pregnancy. Obstet Gynecol Surv. 2005;60(10):672–82. https://pubmed.ncbi.nlm.nih.gov/16186784. https://doi.org/10.1097/01.ogx.0000180889.23678.fb.

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):104–9. https://pubmed.ncbi.nlm.nih.gov/19138316. https://doi.org/10.1111/j.1365-2265.2008.03495.x.

Downloads

Published

2024-02-08

How to Cite

Loh, Y. D., & Mohd Ali, M. H. (2024). Primary Hyperparathyroidism during Pregnancy: Two Tales with Different Outcomes. Journal of the ASEAN Federation of Endocrine Societies, 39(1), 115–119. https://doi.org/10.15605/jafes.039.01.17

Issue

Section

Case Series