title: Hyperparathyroidism in pregnancy: options for localization and surgical therapy.
abstract: BACKGROUND
  Hyperparathyroidism in pregnancy is a threat to the health of both mother and fetus. The mothers suffer commonly from nephrolithiasis, hyperemesis, or even hypercalcemic crisis. Untreated disease will commonly complicate fetal development and fetal death is a significant risk. Treatment options, including medical and surgical therapy, are debated in the literature.
  
  
  METHODS
  This is a case series comprising seven patients with primary hyperparathyroidism in pregnancy. Data collected included symptoms at diagnosis, biochemical abnormalities, pathologic findings, treatment regimes, and subsequent maternal and fetal outcomes.
  
  
  RESULTS
  Seven women, aged 20 to 39 years, presented with hyperparathyroidism during pregnancy. The earliest presented at 8 weeks and the latest at 38 weeks. Four of seven patients experienced renal calculi. Calcium levels were 2.7-3.5 mmol/l. All were found to have solitary parathyroid adenomas, of which two were in ectopic locations. Fetal complications included three preterm deliveries and one fetal death with no cases of neonatal tetany. Maternal and fetal complications could not be predicted based on duration or severity of hypercalcemia. Three patients were treated during pregnancy with surgery, and two of these had ectopic glands that required reoperations with a novel approach using Tc-99m sestamibi scanning during pregnancy to assist in localizing the abnormal gland. Four cases were treated postpartum with a combination of open and minimally invasive approaches after localization. No operative complications or fetal loss related to surgery were observed in this cohort.
  
  
  CONCLUSIONS
  Primary hyperparathyroidism in pregnancy represents a significant risk for maternal and fetal complications that cannot be predicted by duration of symptoms or serum calcium levels. Surgical treatment should be considered early, and a minimally invasive approach with ultrasound is best suited to mitigating risk to mother and fetus. Equally important, Tc-99m sestamibi imaging may be used safely for localization of the parathyroids after negative cervical explorations.
authors.affiliation: Department of Surgery 2D, Walter C. Mackenzie Health Science Centre, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada. todd.mcmullen@ualberta.net
authors.forename: Todd P W
authors.initials: TP
authors.lastname: McMullen
authors.forename: Diana L
authors.initials: DL
authors.lastname: Learoyd
authors.forename: David C
authors.initials: DC
authors.lastname: Williams
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sywak
authors.forename: Stan B
authors.initials: SB
authors.lastname: Sidhu
authors.forename: Leigh W
authors.initials: LW
authors.lastname: Delbridge
mesh_terms: D000328:Adult; D005260:Female; D005313:Fetal Death; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D007231:Infant, Newborn; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D011256:Pregnancy Outcome; D047928:Premature Birth; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
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