DIAGNOSIS
OF PRIMARY HYPERPARATHYROIDISM DURING PREGNANCY
Diagnosis
of primary hyperparathyroidism (PHPT) is basically biochemical and is based on
the combination of increased serum calcium levels and inappropriately increased
parathormone (PTH) levels. This definition could be applied during pregnancy,
but the physiological changes associated with pregnancy may result in low total
serum calcium levels and thus mask PHPT. Moreover, calcium levels are not
typically measured during pregnancy or in women planning / wishing pregnancy.
Increased ionized serum calcium levels and/or hypophosphatemia should be viewed
with a high index of suspicion for the diagnosis of PHPT. If these biochemical
abnormalities are associated with increased PTH levels, the diagnosis of PHPT
is confirmed. PHPT should also be suspected in the presence of the classic
clinical manifestations of PHPT (such as recurrent nephrolithiasis,
pancreatitis, pathologic bone fracture, etc). Hereditary syndromes associated
with PHPT (such as MEN-1, MEN-2, familial parathyroid hyperplasia syndrome, jaw
tumor syndrome, and benign familial hypocalciuric hypercalcemia) should be
excluded, given the young age of the pregnant women.
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