Hypercalcemia in pregnancy – a multifaceted challenge: case reports and literature review

Abstract

Key Clinical MessageHypercalcemia in pregnancy is an uncommon event that can cause major maternal morbidity and/or fetal or neonatal morbidity and mortality. Management is a challenge for the clinicians, especially as regards to investigations in pregnancy, surgery, and the use of cinacalcet and bisphosphonates. We present three case reports and discuss management.

Hiperparatireoidismo primário na gravidez tratado com bisfosfonatos

“…Cinacalcet is a calcimimetic agent that binds to the calcium-sensing receptor (CaSR), activating CaSR to react to the extracellular calcium concentration and decrease PTH secretion. It is effective in all forms of hyperparathyroidism but is mainly used for the treatment of secondary hyperparathyroidism and parathyroid carcinoma 12 . As CaSRs are present in the placenta, cinacalcet may alter placental function and potentially induce fetal and neonatal hypocalcemia.…”

“…They are incorporated into active bone remodelling sites and suppress bone turnover by inhibiting bone mineral breakdown. Consequently, there is a decrease in calcium release and levels of serum calcium, an increase in bone mineral density, and an improvement in bone quality 12 . Bisphosphonates cross the placenta.…”

Review article: Investigations and the pregnant woman in the emergency department – part 1: Laboratory investigations

“…Primary hyperparathyroidism is the most common cause of hypercalcaemia in pregnancy . Other important causes include milk‐alkali syndrome (triad of hypercalcaemia, alkalosis and AKI), familial hypocalciuric hypercalcaemia and PTHrP mediated hypercalcaemia.…”

Primary hyperparathyroidism in pregnancy — a review of literature

“…Calcimimetics has not been widely used in pregnancy. There are only three cases described in literature [29][30][31]. In two of them, cinacalcet was given only for two weeks before the delivery.…”