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Hyperparathyroidism during pregnancy

F L Delmonico, R M Neer, A B Cosimi

    American Journal of Surgery
    |March 1, 1976
    PubMed
    Summary
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    Hyperparathyroidism in pregnancy significantly increases risks for newborns, including tetany and death. Surgical intervention during pregnancy can reduce these neonatal complications.

    Area of Science:

    • Obstetrics and Gynecology
    • Endocrinology
    • Neonatology

    Background:

    • Hyperparathyroidism during pregnancy is linked to adverse neonatal outcomes.
    • Increasing numbers of renal transplant recipients and routine serum chemistry screening may increase diagnosis frequency.

    Observation:

    • A review of cases since 1962 showed 80% of hyperparathyroid pregnancies resulted in neonatal complications like tetany, death, or abortion.
    • Despite medical advances, neonatal complications remain high, with one report noting 50% incidence.

    Findings:

    • Transplacental calcium passage in hypercalcemic pregnancies causes fetal hypercalcemia, potentially leading to in utero parathyroid suppression.
    • This suppression can result in neonatal tetany or permanent hypoparathyroidism.
    • Parathyroid resection during pregnancy, though rare (8 reported cases), significantly reduced neonatal complications.

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    Implications:

    • Suggests parathyroid surgery in the second trimester for significant hypercalcemic hyperparathyroidism during pregnancy.
    • Recommends close neonatal monitoring of calcium levels post-delivery.
    • Advises avoiding high-phosphate formulas and favoring those with a calcium:phosphorus ratio similar to human milk.