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Primary hyperparathyroidism in pregnancy: evidence-based management.

Peter F Schnatz1, Stephen L Curry

  • 1The University of Connecticut School of Medicine, Farmington, USA. pschnat@harthosp.org

Obstetrical & Gynecological Survey
|July 26, 2002
PubMed
Summary

Primary hyperparathyroidism in pregnancy presents risks but prompt diagnosis and management improve outcomes. Surgical removal of parathyroid adenomas is definitive, even with third-trimester surgery showing success.

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Area of Science:

  • Endocrinology
  • Obstetrics
  • Gynecology

Background:

  • Primary hyperparathyroidism (PHP) affects 0.15% of the population, with 25% of cases in women of childbearing age.
  • PHP in pregnancy is often asymptomatic (up to 80%), complicating diagnosis.
  • Maternal and fetal complications are significant, occurring in up to 67% and 80% of cases, respectively.

Purpose of the Study:

  • To review the literature on primary hyperparathyroidism in pregnancy.
  • To propose an evidence-based management approach for pregnant patients with PHP.
  • To address controversies in managing PHP, particularly late in gestation.

Main Methods:

  • Literature review of primary hyperparathyroidism in pregnancy.
  • Analysis of maternal and fetal complications.

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  • Evaluation of treatment options, including conservative management and surgical intervention.

    • Main Results:

    • Maternal complications include nephrolithiasis, pancreatitis, and hypercalcemic crisis.
    • Fetal complications include intrauterine growth retardation, low birth weight, and preterm delivery.
    • Appropriate therapy can decrease perinatal complications by four-fold.

    Conclusions:

    • Parathyroid adenoma excision is the only definitive treatment for PHP.
    • Conservative management may be suitable in specific circumstances.
    • Successful third-trimester surgery for PHP in pregnancy has been reported, despite ongoing debate.