Seventeen Cases of Primary Hyperparathyroidism in Pregnancy : A Call for Management Guidelines
CONTEXT: The risks of primary hyperparathyroidism (pHPT) to pregnant women and their fetuses appear to increase commensurate with serum calcium levels. The management strategy for pHPT must be adapted in pregnancy and should reflect the severity of hypercalcemia. However, no guidelines exist to assist clinicians.
METHODS: The experience of a high-volume multidisciplinary endocrine surgical service in treating a consecutive series of pregnant women with pHPT referred for parathyroidectomy is presented and data are compared with a nonpregnant cohort with pHPT. A review of pHPT and pregnancy outcomes in the literature is provided.
RESULTS: Seventeen pregnant women and 247 age range-matched nonpregnant women with pHPT were referred for surgery over 11 years. Mean serum calcium level was higher in the pregnant cohort (2.89 vs 2.78 mmol/L; P = 0.03). Preoperative localization with ultrasound succeeded in eight pregnant women (47%) and sestamibi scanning did in two of six (33% imaged preconception), compared with 84 (34%) and 102 (42%) control subjects, respectively (not significant). Parathyroidectomy was performed under general anesthesia between 12 and 28 weeks' gestation with no adverse pregnancy outcomes resulting. Cure rate was 100% vs 96% in controls.
CONCLUSION: pHPT in pregnancy is a threat to mother and child. Medical management may be appropriate in mild disease, but in moderate to severe disease, parathyroidectomy under general anesthesia in the second trimester is safe. Localization using ionizing radiation/MRI is unnecessary, because surgical intervention in a high-volume multidisciplinary setting has excellent outcomes. Guidelines on the topic would assist clinicians.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:3 |
|---|---|
| Enthalten in: |
Journal of the Endocrine Society - 3(2019), 5 vom: 01. Mai, Seite 1009-1021 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
DiMarco, Aimee Natasha [VerfasserIn] |
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| Links: |
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| Themen: |
Endocrine disorders in pregnancy |
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| Anmerkungen: |
Date Revised 08.04.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1210/js.2018-00340 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM296849936 |
|---|
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| 245 | 1 | 0 | |a Seventeen Cases of Primary Hyperparathyroidism in Pregnancy |b A Call for Management Guidelines |
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| 500 | |a Date Revised 08.04.2022 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a CONTEXT: The risks of primary hyperparathyroidism (pHPT) to pregnant women and their fetuses appear to increase commensurate with serum calcium levels. The management strategy for pHPT must be adapted in pregnancy and should reflect the severity of hypercalcemia. However, no guidelines exist to assist clinicians | ||
| 520 | |a METHODS: The experience of a high-volume multidisciplinary endocrine surgical service in treating a consecutive series of pregnant women with pHPT referred for parathyroidectomy is presented and data are compared with a nonpregnant cohort with pHPT. A review of pHPT and pregnancy outcomes in the literature is provided | ||
| 520 | |a RESULTS: Seventeen pregnant women and 247 age range-matched nonpregnant women with pHPT were referred for surgery over 11 years. Mean serum calcium level was higher in the pregnant cohort (2.89 vs 2.78 mmol/L; P = 0.03). Preoperative localization with ultrasound succeeded in eight pregnant women (47%) and sestamibi scanning did in two of six (33% imaged preconception), compared with 84 (34%) and 102 (42%) control subjects, respectively (not significant). Parathyroidectomy was performed under general anesthesia between 12 and 28 weeks' gestation with no adverse pregnancy outcomes resulting. Cure rate was 100% vs 96% in controls | ||
| 520 | |a CONCLUSION: pHPT in pregnancy is a threat to mother and child. Medical management may be appropriate in mild disease, but in moderate to severe disease, parathyroidectomy under general anesthesia in the second trimester is safe. Localization using ionizing radiation/MRI is unnecessary, because surgical intervention in a high-volume multidisciplinary setting has excellent outcomes. Guidelines on the topic would assist clinicians | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a endocrine disorders in pregnancy | |
| 650 | 4 | |a pregnancy | |
| 650 | 4 | |a primary hyperparathyroidism | |
| 700 | 1 | |a Meeran, Karim |e verfasserin |4 aut | |
| 700 | 1 | |a Christakis, Ioannis |e verfasserin |4 aut | |
| 700 | 1 | |a Sodhi, Vinpreet |e verfasserin |4 aut | |
| 700 | 1 | |a Nelson-Piercy, Catherine |e verfasserin |4 aut | |
| 700 | 1 | |a Tolley, Neil Samuel |e verfasserin |4 aut | |
| 700 | 1 | |a Palazzo, Francesco Fausto |e verfasserin |4 aut | |
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