Primary hyperparathyroidism in pregnancy: evidence-based management.
Primary hyperparathyroidism during pregnancy poses significant risks to the mother and the fetus. Fortunately, prompt diagnosis and effective management can improve outcomes for both. There is controversy regarding appropriate management of these patients, especially late in gestation. The objective of this article, therefore, is to review the literature and to propose an evidence-based approach to managing these patients. The prevalence of primary hyperparathyroidism in the general population is 0.15%. This condition is more common in women and 25% of cases appear in women during the childbearing years. The true incidence during pregnancy, however, is not known. Because up to 80% of gravid patients with primary hyperparathyroidism are asymptomatic, diagnosing this condition is more difficult. Complications associated with primary hyperparathyroidism in pregnancy have been reported to occur in up to 67% of mothers and 80% of fetuses. In addition to many constitutional symptoms, maternal complications include nephrolithiasis, bone disease, pancreatitis, hyperemesis, muscle weakness, mental status changes, and hypercalcemic crisis. Reported fetal complications include intrauterine growth retardation, low birth weight, preterm delivery, intrauterine fetal demise, postpartum neonatal tetany, and permanent hypoparathyroidism. A four-fold decrease in perinatal complications may be achieved with appropriate therapy. Conservative intervention may be appropriate under certain circumstances, but excision of a parathyroid adenoma remains the only definitive treatment. Debate continues regarding the safety of surgery in the third trimester. However, several cases of successful surgery have been reported.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader will be able to describe the typical presentation of a patient with hyperparathyroidism, summarize the work up and management of a patient with hyperparathyroidism, and list the treatment options for a pregnant patient with hyperparathyroidism.
The University of Connecticut School of Medicine, Farmington, USA. pschnat@harthosp.org
Peter F
PF
Schnatz
Stephen L
SL
Curry
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery; D000465:Algorithms; D002118:Calcium / Q000378:metabolism; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000601:surgery; D015994:Incidence; D010281:Parathyroid Hormone / Q000378:metabolism; D044162:Parathyroid Hormone-Related Protein; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D016105:Parathyroidectomy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery; D011506:Proteins / Q000378:metabolism
C470121:PTHLH protein, human; D010281:Parathyroid Hormone; D044162:Parathyroid Hormone-Related Protein; D011506:Proteins; D002118:Calcium