Diagnosis and treatment of primary hyperparathyroidism in pregnancy: analysis of six cases / 中华围产医学杂志

ABSTRACT

Objective:To study the clinical manifestations, diagnosis and treatment of primary hyperparathyroidism (PHPT) in pregnancy.Methods:This study involved six pregnant patients with PHPT who were admitted to Ruijin Hospital of Shanghai Jiao Tong University from August 2014 to November 2019. Their clinical manifestations, treatment strategies (multidisciplinary consultation with departments including Obstetrics, Endocrinology, Neonatology, General Surgery, Anesthesiology and Intensive Care Unit), maternal complications and maternal and infant outcomes were described and retrospectively analyzed.Results:(1) The median age of the six patients was 34(23-38) years old. PHPT was diagnosed in one case before pregnancy, four in the second or third trimester and one after delivery. The main clinical manifestations of four cases were nausea, vomiting, anorexia and other non-specific symptoms. Anemia was the most common maternal complication (five cases). Other complications included hypercalcemia crisis with renal failure (one case), multiple bone destruction and osteoporosis (one case). The median levels of serum calcium, parathyroid hormone and 25-hydroxyvitamin D were 3.08 (2.84-4.21) mmol/L, 216.7(93.1-2 603.6) ng/L and 29.66 (13.50-90.24) nmol/L, respectively. Results of parathyroid ultrasonography showed all patients had hypoechoic focus. Four cases underwent routine parathyroid radionuclide imaging showing abnormal radioactive concentration areas. (2) Obstetricians initiated the multidisciplinary team (MDT) for all patients to determine the treatment plans after communication with the patients and their families. One case received surgical treatment five months after delivery. Three cases received surgical treatment in the second trimester and among them, one terminated the pregnancy in the second trimester and the other two continued and achieved good pregnancy outcomes. Two cases underwent surgical treatment after giving up pregnancy and induced abortion. Postoperative pathology revealed that five cases were isolated parathyroid adenoma and one was parathyroid carcinoma. All of the patients were followed up and no abnormal serum calcium was reported. (3) One newborn had hypocalcemic convulsions one month after birth and was recovered by intravenous calcium supplementation. The newborn was followed up and the serum calcium level was normal so far. The other two neonates had normal serum calcium during follow-ups, but one of them was diagnosed with autism at the age of four and is now undergoing rehabilitation treatment.Conclusions:Pregnancy complicated by PHPT may lead to serious maternal and infant complications. MDT consultation ensures timely diagnosis, comprehensive treatment for the patients and better pregnancy outcomes.