Effect of Pregnancy and of the Menstrual Cycle on Hypoparathyroidism

Graham, William P.; Gordan, Gilbert S.; Löken, Hans F.; Blum, Andrea; Halden, Allan

doi:10.1210/jcem-24-6-512

Cited by 33 publications

(11 citation statements)

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“…The author is aware of other unpublished cases in which hypoparathyroidism improved during pregnancy and calcitriol was either significantly decreased or stopped. A report of 10 cases of hypoparathyroidism found that the ionized calcium was normal during pregnancy with 2 g supplemental calcium and either vitamin D 2 or D 3 but no calcitriol, and that the only change that occurred was a marked decrease in the albumin-bound fraction of serum calcium (340). These improvements in hypoparathyroidism during pregnancy imply that upregulation of calcitriol and/or intestinal calcium absorption occurs, which is consistent with the rodent models.…”

Section: Human Datamentioning

confidence: 61%

“…Multiple case reports described that hypoparathyroidism improves during pregnancy, with subjective evidence of fewer hypocalcemic symptoms or objective evidence of reduced maternal requirement for calcitriol, 1␣-hydroxyvitamin D, vitamin D, and supplemental calcium (88,120,213,285,340,343,747,777,785,890). In the most well documented of these cases, calcitriol had to be progressively decreased and then stopped due to recurrent hypercalcemia, and the patient was then managed solely on 1.2 g calcium daily during the third trimester (890).…”

Section: Human Datamentioning

confidence: 99%

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Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

384

524

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During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ϳ30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

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Section: Human Datamentioning

confidence: 61%

Section: Human Datamentioning

confidence: 99%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

384

524

View full text Add to dashboard Cite

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“…Reasoning " Serum total calcium falls in normal pregnancy due to haemodilution-induced reductions in serum albumin levels, but ionized calcium remains stable (29,100). Thus, in pregnant women with HypoPT, serum ionized calcium is the preferred parameter that should be frequently monitored (e.g.…”

Section: Special Circumstancesmentioning

confidence: 99%

European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults

Bollerslev¹,

Rejnmark²,

Marcocci³

et al. 2015

European Journal of Endocrinology

385

411

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Hypoparathyroidism (HypoPT) is a rare (orphan) endocrine disease with low calcium and inappropriately low (insufficient) circulating parathyroid hormone levels, most often in adults secondary to thyroid surgery. Standard treatment is activated vitamin D analogues and calcium supplementation and not replacement of the lacking hormone, as in other hormonal deficiency states. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of chronic HypoPT in adults who do not have end-stage renal disease. We intend to draft a practical guideline, focusing on operationalized recommendations deemed to be useful in the daily management of patients. This guideline was developed and solely sponsored by The European Society of Endocrinology, supported by CBO (Dutch Institute for Health Care Improvement) and based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles as a methodological base. The clinical question on which the systematic literature search was based and for which available evidence was synthesized was: what is the best treatment for adult patients with chronic HypoPT? This systematic search found 1100 articles, which was reduced to 312 based on title and abstract. The working group assessed these for eligibility in more detail, and 32 full-text articles were assessed. For the final recommendations, other literature was also taken into account. Little evidence is available on how best to treat HypoPT. Data on quality of life and the risk of complications have just started to emerge, and clinical trials on how to optimize therapy are essentially non-existent. Most studies are of limited sample size, hampering firm conclusions. No studies are available relating target calcium levels with clinically relevant endpoints. Hence it is not possible to formulate recommendations based on strict evidence. This guideline is therefore mainly based on how patients are managed in clinical practice, as reported in small case series and based on the experiences of the authors. (2015) 173, G1-G20 European Journal of Endocrinology Summary of recommendationsThe recommendations are worded as recommend (strong recommendation) and suggest (weak recommendation). We formally graded only the evidence underlying recommendations for therapeutic choices and target calcium levels. The quality of evidence behind the recommendations is classified as very low (4BBB), low (44BB), moderate (444B) and strong (4444). See further section 'Summary of methods used for guideline development'. European Journal of EndocrinologyClinical Practice Guideline J Bollerslev, L Rejnmark and others ESE guideline on treatment of chronic HypoPT

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“…Treated hypoparathyroidism in pregnancy has not previously been noted to require any alteration in maintenance therapy (Anderson and Musselman, 1942;Graham et at., 1964;O'Leary et al, 1966). The level of serum calcium in these reported cases was carefully followed during the pregnancy and again at varying intervals afterwards, but not immediately post partum.…”

Section: Introductionmentioning

confidence: 99%

Post-partum Hypercalcaemia in Treated Hypoparathyroidism

Wright¹,

Joplin²,

Dixon³

1969

BMJ

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Bone Scanning with Strontium-85-Parsons et al.MEDICBL JOURNAL 23 have revealed the presence of bony changes which had been barely visible in previous radiographs. This may reflect the clinicians' poor prediction rather than radiological technique. On occasion, while scanning one area under suspicion another, totally unexpected, area will appear active, and when this is examined radiologically the bony changes are apparent. In this situation scanning has supplemented but in no way replaced radiology. Because of the limited areas scanned in this group of patients, coupled with the frequent occurrence of crush and healing fractures, the biochemical indices of overall bone diseases are difficult to compare with the scanning results. In three patients increased excretion of hydroxyproline containing peptides was the only positive biochemical finding which correlated with a positive scan, and this finding needs to be confirmed in a larger series.Malignancy was suspected in three patients, but biopsy in one showed a tuberculous abscess and in the other two the symptoms receded with antibiotic therapy-a reminder that not all vertebral disease in patients with a past history of malignant disease need be metastatic.

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Effect of Pregnancy and of the Menstrual Cycle on Hypoparathyroidism

Cited by 33 publications

References 0 publications

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults

Post-partum Hypercalcaemia in Treated Hypoparathyroidism

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