Hypercalcaemia during pregnancy: Review of maternal and fetal complications, investigations, and management

Gehlert, Jessica; Morton, Adam

doi:10.1177/1753495x18799569

Cited by 16 publications

(14 citation statements)

References 32 publications

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“…For pregnant patients with PHPT with asymptomatic, mildly elevated, serum calcium levels or patients who do not accept surgery, close observation without surgical intervention is feasible [ 19 , 20 ]. The first-line medication is oral or intravenous rehydration with or without furosemide, which is safe, can avoid iatrogenic placental hypoperfusion or oligohydramnios caused by dehydration [ 21 ] and will not increase the risk of obstetric complications, such as abortion.…”

Section: Discussionmentioning

confidence: 99%

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

Jiao

Sun

Liu

et al. 2021

BMC Pregnancy Childbirth

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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.

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Section: Discussionmentioning

confidence: 99%

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

Jiao

Sun

Liu

et al. 2021

BMC Pregnancy Childbirth

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“…The lack of characterized symptoms of PHPT during pregnancy is another reason for the misdiagnosis. A previous study of women with severe symptomatic hypercalcemia in pregnancy showed a significantly higher risk of developing maternal-fetus complications [4] . Deteriorating hypercalcemia may cause a hypercalcemic crisis during pregnancy, a life-threatening complication to both mother and fetus.…”

Section: Introductionmentioning

confidence: 94%

“…A previous study of women with severe symptomatic hypercalcemia in pregnancy showed a significantly higher risk of developing maternal-fetus complications. [ 4 ] Deteriorating hypercalcemia may cause a hypercalcemic crisis during pregnancy, a life-threatening complication to both mother and fetus. Therefore, early diagnosis and treatment of PHPT are critical.…”

Section: Introductionmentioning

confidence: 99%

Primary hyperparathyroidism presenting as a brown tumor with hypercalcemia crisis in a second-trimester pregnant woman

2021

Medicine

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Introduction: Primary hyperparathyroidism (PHPT) in pregnancy is rare and unrecognized because the maternal physiological adaptations blurs the symptoms. There is no standard treatment strategy for maternal PHPT. Early diagnosis and interventions can prevent catastrophic consequences to the mother and fetus. Patient concerns: A 31-year-old Chinese woman was admitted, due to a lump on the left lower leg for 4 months. The patient complained of mild pain in the left lower leg following exercise that could be relieved after a short rest. The patient was at 18 weeks of gestation, and the growth of the fetus was normal. The patient has a 3-year history of hypercalcemia and a 2-year history of nephrolithiasis. No family history of hypercalcemia and endocrine tumors were present. Diagnosis: Laboratory tests demonstrated high serum calcium level of 3.84 mmol/L, parathyroid hormone 1393 pg/mL, alkaline phosphatase 488 μ/L. Ultrasound showed a 22.4 mm × 7.8 mm solid nodule in the left lower lobe of the thyroid gland. Based on these findings, the patient was diagnosed with PHPT. Interventions: The patient accepted continuous renal replacement to reduce ironized calcium level. Parathyroidectomy was performed at the 19th week of gestation. Threatened abortion occurred 2 days after the surgery, and magnesium sulfate was used to prevent the abortion. Calcium gluconate, calcium carbonate and vitamin D3 were used to treat the hypocalcemia that occurred 5 days after the surgery. Outcomes: Pathology examination demonstrated the parathyroid adenoma. Abortion was prevented using magnesium sulfate and hypocalcemia was cured with calcium gluconate, calcium carbonate and vitamin D3. At 38-week of gestation, the patient (ionized calcium level: 2.16 mmol/L) delivered a healthy female baby weighing 2700 g with 10/10 Apgar. Till now, both the mother and infant showed no complications. Conclusion: Maternal PHPT is rare and challenging to diagnose, causing life-threatening complications to mother and fetus. Any decision regarding surgery for a pregnant woman with primary hyperparathyroidism is more complex than in men or nonpregnant women. The decision should be made based on the severity of hypercalcemia and symptoms.

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“…The sensitivity of ultrasound is lower in multiglandular disease and may be only 15-35% [77,78]. Magnetic resonance imaging (MRI) can be used [79], however, it has a sensitivity of 82% [80] in detecting parathyroid adenoma and should not be used as a single imaging modality in localizing parathyroid adenoma [81]. MRI with gadolinium contrast should be limited in pregnancy since this agent is water-soluble and may cross the placenta [82].…”

Section: Localizationmentioning

confidence: 99%

Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management

Ali

Dandurand

Khan

2021

JCM

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Background: Parathyroid disease is uncommon in pregnancy. During pregnancy, multiple changes occur in the calcium regulating hormones which may make the diagnosis of primary hyperparathyroidism more challenging. Close monitoring of serum calcium during pregnancy is necessary in order to optimize maternal and fetal outcomes. In this review, we will describe the diagnosis and management of primary hyperparathyroidism during pregnancy. Methods: We searched MEDLINE, CINAHL, EMBASE and Google scholar bases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters and clinical guidelines were included in this review. Conclusions: Medical management options for primary hyperparathyroidism during pregnancy are severely limited due to inadequate safety data with the various potential therapies available, and surgery is advised during the 2nd trimester of pregnancy in the presence of severe hypercalcemia (calcium adjusted for albumin greater than 3.0 mmol/L (12.0 mg/dL)). Hypercalcemia should be avoided during pregnancy in order to minimize maternal and fetal complications.

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Hypercalcaemia during pregnancy: Review of maternal and fetal complications, investigations, and management

Cited by 16 publications

References 32 publications

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

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

Primary hyperparathyroidism presenting as a brown tumor with hypercalcemia crisis in a second-trimester pregnant woman

Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management

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