Primary hyperparathyroidism during pregnancy

To provide an up-to-date review of primary hyperparathyroidism (HPT) as a complication of pregnancy.

We discuss the initial manifestations of primary HPT in pregnant patients, the diagnosis, the differential diagnosis of hypercalcemia, and the recommended treatment strategies.

In the nonpregnant state, 50 to 80% of patients with primary HPT are asymptomatic. In contrast, pregnant patients with primary HPT have a wide variety of symptoms and findings: gastrointestinal symptoms (nausea, vomiting, and anorexia), weakness and fatigue, headaches and confusion, nephrolithiasis, bone disease, pancreatitis, urinary tract infection, and hypertension. Occasionally, neonatal hypocalcemia is the initial manifestation of maternal HPT. Diagnosis of primary HPT during pregnancy is dependent on the clinical history and laboratory findings. In general, management of maternal primary HPT during pregnancy should be individualized and based on the patient's symptoms, general medical condition, severity of disease, and gestational stage at the time of diagnosis. If HPT is diagnosed during the first two trimesters, surgical intervention is the treatment of choice.

Although uncommon, HPT during pregnancy may be associated with maternal and perinatal complications. Therefore, clinicians should be aware of the usual characteristics of this disorder and the preferred management options.