PRIMARY
HYPERPARATHRYOIDISM AND PREGNANCY
PHPT is not
common during pregnancy. Moderate or severe hypercalcemia during pregnancy may,
however, expose the mother and the fetus to significant risks. Maternal
complications of severe hypercalcemia include hyperemesis, nephrolithiasis or
nephrocalcinosis, recurrent urinary tract infection, pancreatitis etc. Complications
from the fetus include hypocalcemia and tetany, due to PTH suppression, preterm
delivery, low birth weight etc.
In
interpreting the severity of hypercalcemia, the physician should keep in
his/her mind that serum concentration of calcium declines with the evolution of
pregnancy, mainly due to significant plasma volume expansion. For this reason,
upper normal limit of calcium serum concentration is 9.5 mg/dL during pregnancy.
In general,
in most cases of asymptomatic or very mild PHPT during pregnancy observation is
the preferred treatment option. However, surgery may be required in cases of
severe hypercalcemia or symptomatic PHPT. Surgery can be safely performed
during the second trimester. Surgery should be avoided during the first
trimester to avoid potential damage to the fetus during organogenesis and during
the third trimester to avoid premature labor. For preoperative localization of
the hyperfunctioning parathyroid parenchyma during pregnancy neck
ultrasonography should be utilized. Parathyroid scintigraphy (sestamibi scan)
and computed tomography are contraindicated due to radiation exposure. Magnetic
resonance imaging, if necessary, is safe during surgery. Hypocalcemia in the
newborn (due to suppression of fetal parathyroid glands) is an important complication
which should be taken into consideration by the neonatologist.
Management
of PHPT known before pregnancy should be performed prior to conception.
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