Primary Hyperparathyroidism In a Twin Pregnancy and Review of Fetal/Maternal Calcium Homeostasis

Haenel, Louis C.; Mayfield, Ronald K.

doi:10.1016/s0002-9629(15)40720-7

Cited by 30 publications

(12 citation statements)

References 26 publications

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“…The existing literature describing the consequences of gestational PHPT is limited, and mainly consists of case reports or case series (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28). In total, these studies reported 33 pregnancies in women with PHPT, who did not undergo surgery.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in women with primary hyperparathyroidism

Abood

Vestergaard

2014

European Journal of Endocrinology

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Objective: To study pregnancy and pregnancy outcomes in women with primary hyperparathyroidism (PHPT) and in controls. Design: Register-based retrospective cohort study of women aged 16-44 years with a diagnosis of PHPT with age-and gender-matched non-exposed controls in Denmark. Methods: The patients and controls were identified using the Danish National Hospital Discharge Register for the period 1977-2010. The outcomes were determined using the Birth Register, the Abortion Register and the LPR (National Hospital Discharge Register). The primary outcome was the relative risk of abortions in patients compared with controls. Results: A total of 1057 women with PHPT and 3171 controls were identified. The number of women giving birth and experiencing abortions did not differ between the two groups (live births, PZ0.21 and abortions, PZ0.12). Also birth weight, length, Apgar score, and gestation length at abortion did not differ. Within the first year after the diagnosis was made, gestation length was lower in women with PHPT than that in controls. However, this was linked to more deliveries by caesarian sections. Conclusions: A diagnosis of PHPT did not seem to increase the rate of abortions in our study. Reducing the abortion risk may therefore not be an indication for parathyroidectomy during pregnancy in patients with mild PHPT. The PHPT diagnosis does not seem to affect birth weight, length and Apgar score. The higher number of deliveries by cesarean section after the diagnosis was made may be associated with lower gestation age. The strategy for delivery should be carefully considered in pregnant women with PHPT.

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Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes in women with primary hyperparathyroidism

Abood

Vestergaard

2014

European Journal of Endocrinology

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“…Several hundred cases have been described in English-language medical journals (354,391,466), while the author's advice has been sought for several cases each year by clinicians around the globe. Primary hyperparathyroidism is 10 -20 times more likely to occur in women over age 45 than in women of child-bearing age (373,980), but in two case series, ϳ1% of all parathyroidectomies were done in pregnant women (466,490).…”

Section: Mineral Metabolism During Pregnancy and Lactationmentioning

confidence: 99%

“…A retrospective review found significantly fewer neonatal deaths and complications in surgically treated mothers compared with the medically managed group (466). The second trimester is considered to have a lower risk of anesthetic or surgical complications, precipitated delivery, and neonatal death, compared with surgery during the third trimester (153,236,508,824), although individual case reports have supported the apparent safety of third trimester surgery (354,662,711,802).…”

Section: Mineral Metabolism During Pregnancy and Lactationmentioning

confidence: 99%

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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“…16 Other factors that could contribute to neonatal hypocalcaemia, include hypomagnesemia, elevated calcitonin levels (from intrauterine hypercalcemia), prematurity and the high phosphate content of infant formula. 17,18 The role of medical management of primary hyperparathyroidism diagnosed during pregnancy is mostly supportive with vigilant obstetrical care. Adequate hydration has been a primary therapy for treating asymptomatic, mild disease.…”

Section: Discussionmentioning

confidence: 99%

Parathyroid surgery in pregnancy: review of the literature and localization by aspiration for parathyroid hormone levels

Pothiwala

Levine

2009

J Perinatol

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Objective: To review the management of primary hyperparathyroidism in pregnant women by focusing on the use of preoperative localization procedures and minimally invasive parathyroid surgery during pregnancy.Study Design: We report the clinical course of two pregnant women with severe hypercalcemia due to primary hyperparathyroidism, as well as review the literature.Results: Primary hyperparathyroidism in pregnant women is associated with high prevalence of maternal and neonatal complications. In women, with severe hypercalcemia, parathyroid surgery during pregnancy reduces fetal and maternal morbidities. Preoperative localization of parathyroid adenomas during pregnancy remains challenging. In selected cases aspiration of nodules suspected of being parathyroid adenomas with the measurement of the parathyroid hormone (PTH) from the aspirate can localize the adenoma, and allow the surgeon to carry out a minimally invasive parathyroidectomy. Conclusion:Localization of a suspected parathyroid adenoma by ultrasound-guided aspiration of a lesion and the measurement of the PTH has previously been described in non-pregnant women. Our review of the literature did not identify any previous case of a pregnant woman with primary hyperparathyroidism, where preoperative localization of a parathyroid adenoma was accomplished by aspiration of a suspected lesion followed by a successful minimally invasive parathyroidectomy carried out during pregnancy.

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Primary Hyperparathyroidism In a Twin Pregnancy and Review of Fetal/Maternal Calcium Homeostasis

Cited by 30 publications

References 26 publications

Pregnancy outcomes in women with primary hyperparathyroidism

Pregnancy outcomes in women with primary hyperparathyroidism

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

Parathyroid surgery in pregnancy: review of the literature and localization by aspiration for parathyroid hormone levels

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