Non-surgical management of primary hyperparathyroidism

Cetani, Filomena; Saponaro, Federica; Marcocci, Claudio

doi:10.1016/j.beem.2018.09.006

Cited by 26 publications

(17 citation statements)

References 66 publications

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“…Nevertheless, surgery has been safely performed in the first and third trimesters 18. Timely management is essential to decrease the risks to mother and fetus; however, it does not eliminate the risk entirely 19. This was demonstrated when our mother developed pre-eclampsia and intrauterine growth restriction (IUGR) despite effective surgery in the second trimester.…”

Section: Discussionmentioning

confidence: 92%

Hyperparathyroidism in pregnancy

Davis

Nippita

2020

BMJ Case Rep

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Hyperparathyroidism is a rare disease during pregnancy, which has increased risks, including miscarriage and fetal growth restriction. However, the diagnosis of hyperparathyroidism is frequently not recognised or delayed as symptoms are non-specific and calcium is not routinely measured. With a thorough medical history and clinical suspicion, early diagnosis and treatment can reduce the risk of some pregnancy complications. A 35-year-old woman presented at 13/40 with hyperemesis gravidarum. She had elevated serum calcium and a parathyroid lesion on ultrasound. She underwent a parathyroidectomy with rapid normalisation of her calcium. Histopathology confirmed a parafibromin-deficient parathyroid tumour, suggestive of hyperparathyroidism jaw tumour syndrome. At 30/40, she presented with pre-eclampsia (hypertension, hyper-reflexia, proteinuria and intrauterine growth restriction) and had a caesarean section at 30+1/40, delivering a male infant, 897 g (fifth percentile). She had a prior 12-month history of chronic constipation and nephrolithiasis but was not investigated further despite elevated calcium (2.82 mmol/L).

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Section: Discussionmentioning

confidence: 92%

Hyperparathyroidism in pregnancy

Davis

Nippita

2020

BMJ Case Rep

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“…There are no clinical guidelines regarding management of PHPT in pregnant women. Parathyroidectomy remains the main and the only definitive treatment of PHPT (37). According to the current guidelines it is recommended for every patient with PHPT under the age of 50.…”

Section: Treatmentmentioning

confidence: 99%

“…Furosemide is, however, a category C medication, and should be used with caution, as it carries the risk of placental hypoperfusion, as well as maternal and fetal electrolyte abnormalities. Several data indicate, that low dietary calcium and low vitamin D status might stimulate parathyroid tumor growth and PTH secretion and have a pathogenic role in development of more severe phenotypes of PHPT (37). Therefore, calcium intake should not be restricted and vitamin D deficiency should be corrected, if present, to attain a serum 25(OH)D level above 20 ng/ml (according to some experts even above 30 ng/ml) (37).…”

Section: Treatmentmentioning

confidence: 99%

“…Several data indicate, that low dietary calcium and low vitamin D status might stimulate parathyroid tumor growth and PTH secretion and have a pathogenic role in development of more severe phenotypes of PHPT (37). Therefore, calcium intake should not be restricted and vitamin D deficiency should be corrected, if present, to attain a serum 25(OH)D level above 20 ng/ml (according to some experts even above 30 ng/ml) (37). Vitamin D repletion may lower the risk of postoperative hypocalcemia and hungry bone syndrome in mothers, as well as hypocalcemia in neonates (18,37).…”

Section: Treatmentmentioning

confidence: 99%

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Primary hyperparathyroidism during pregnancy – current approach

Kochman¹

2020

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Primary hyperparathyroidism (PHPT) during pregnancy is a rare, but may cause many maternal and fetal complications. Most cases are mild and very often remain undiagnosed throughout the whole pregnancy period, especially since its symptoms overlap those occurring in normal pregnancy. Additionally, physiological changes in calcium metabolism and PTH secretion may make the diagnosis difficult. Some current data indicate, that in pregnant women with mild PHPT the risk of obstetrical complications do not increase. However, according to others some complications, including miscarriage, intrauterine growth retardation or preeclampsia continue to occur even in subjects with mild hypercalcemia or those previously successfully treated for PHPT. Additionally, the course of PHPT during pregnancy may exacerbate, and rapid severe worsening of hypercalcemia may occur in the postpartum period. Parathyroidectomy, optimally performed during the second trimester, remains the main and the only definite treatment of PHPT, especially, when the serum calcium level exceeds 2,75 mmol/l. In patients with mild, asymptomatic PHPT some experts recommend conservative treatment with postponing surgery to the postpartum period. There are no medical guidelines regarding the treatment of PHPT during pregnancy. Therefore, to achieve optimal care of pregnant women with PHPT, they should be diagnosed, monitored and treated in reference centers by multidisciplinary teams of closely cooperating specialists. Conservative treatment is possible only on condition of close monitoring of the mother and child during pregnancy and after delivery.

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“…[1] Although calcimimetic like cinacalcet has been utilized in PHPT, its impact on reducing calcium is not usually immediate and worsening of nephrocalcinosis has been reported in literature. [2] Denosumab is an option in such patients and in those with hypercalcemia that is refractory to bisphosphonates. Denosumab interferes with RANKL signaling and thereby inhibits bone resorption.…”

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confidence: 99%