ABSTRACT
INTRODUCTION: Primary hyperparathyroidism (PHPT) is rare in pregnancy. PHPT and hypercalcemia are associated with negative maternofetal outcomes. Therefore, an early diagnosis and adequate treatment are essential. CASE PRESENTATION: We described the case of a pregnant woman complaining of nausea, vomiting and weight loss. Diagnosis of gestational PHPT (GPHPT) was made based on elevated serum calcium and parathyroid hormone levels (3.4 mmol/L and 41.6 pmol/L). Neck ultrasound documented a nodule suggestive of enlarged parathyroid, whereas the abdomen ultrasound revealed renal microlithiasis. Conservative treatment was started with oral hydration and a low-calcium diet. Clinical and biochemical monitoring was weekly and multidisciplinary. Despite our suggestion, the patient refused parathyroidectomy in the second trimester. Additional intravenous fluid rehydration from the 15th to the 25th week of gestation ameliorated the symptoms rapidly, and reduced calcium levels progressively from the 23rd week. At week 40, the woman gave birth to a healthy girl. At month 8 postpartum, calcemia and PTH were still elevated, and accompanied by osteoporosis and nephrocalcinosis. Surgery was accepted, and a parathyroid adenoma was removed. CONCLUSION: In the absence of guidelines for GPHPT management, its treatment should be individualized. In our case, despite high calcium levels, conservative treatment with strict monitoring led to a positive outcome of pregnancy.
Subject(s)
Hypercalcemia/therapy , Hyperparathyroidism, Primary/therapy , Pregnancy Complications/therapy , Administration, Oral , Adult , Calcium, Dietary/administration & dosage , Conservative Treatment/methods , Diet Therapy , Female , Fluid Therapy/methods , Humans , Hypercalcemia/etiology , Hyperparathyroidism, Primary/complications , Italy , Parathyroidectomy , Postpartum Period , PregnancyABSTRACT
BACKGROUND: Measurement of serum thyroperoxidase autoantibodies (TPOAb) during gestation as a classical marker for the risk of postpartum thyroiditis (PPT) predicts PPT in 1/3 to 1/2 of women. Very few studies have measured serum thyroid hormone Ab (THAb) during gestation, and none as a possible marker for PPT. METHODS: In 412 women who were followed up from 7 to 11â¯weeks of gestation through 12â¯months after delivery, we measured THAb (T3.IgM, T3.IgG, T4.IgM, T4.IgG), thyroglobulin autoantibodies (TgAb) and TPOAb at study entry (7-11â¯week of gestation). RESULTS: Sixty-three women (15.3%) developed PPT, which progressed to permanent hypothyroidism (PH) in 34/63 (54%). THAb+ve were 21/412 women (5.1%), the frequency being greater in those who then developed PPT (12/63 [19.0%] vs. 9/349 [2.6%], Pâ¯=â¯4.6â¯×â¯10-8), and in the PH subgroup (26.5% [9/34] vs. 10.3% [10/29], Pâ¯=â¯0.12). THAb positivity occurred in 9/76 women (11.8%) who were TgAb and/or TPOAb+ve compared to 12/336 women who were TgAb and TPOAb negative (3.6%, Pâ¯=â¯0.0031). Of these 9 THAb+ve, TgAb and/or TPOAb+ve women, all (100%) developed PPT compared to 3/11 (27.3%, Pâ¯=â¯0.0011) THAb+ve, TgAb and/or TPOAb negative women. Of these 9 and 3 PPT women, 8 and 1 progressed to PH (88.9% and 33.3%, respectively, Pâ¯=â¯0.12). CONCLUSIONS: Gestational positivity of THAb enhance enormously the predictivity for PPT of gestational positivity of TPOAb/TgAb. However, their low frequency (5.1%) and their sensitivity (17.5% [21/63]) go against their application in lieu of TPOAb/TgAb.
ABSTRACT
This report presents the uncommon case of a 154-day delayed delivery in a spontaneous twin pregnancy associated with uterine atony. After abortion of the first fetus at 16 weeks, a healthy male was born at 38 weeks. Postpartum hemorrhage due to uterine atony, which was successfully treated with prostaglandins, occurred.
Subject(s)
Delivery, Obstetric , Twins , Uterine Inertia/physiopathology , Abortion, Spontaneous , Adult , Female , Gestational Age , Humans , Infant, Newborn , Male , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/pathology , Postpartum Hemorrhage/prevention & control , Pregnancy , Pregnancy Outcome , Prostaglandins F/therapeutic use , Uterine Inertia/drug therapyABSTRACT
AIM: We studied morphologic modifications of the endometrium induced by leuprorelin acetate, a gonadotropin-releasing hormone agonist, in women with uterine myomata. METHODS: Transmission and scanning electron microscopy observations were performed after 2 or 6 cycles of therapy (every 28 days). RESULTS: A near-normal endometrium was observed after 2 months of therapy, while treatment with 6 cycles of leuprorelin acetate induced a uniform morphologic regression of the uterine mucosa. CONCLUSIONS: The study demonstrates that leuprorelin acetate induces a unique and time-dependent regression of the endometrial mucous membrane.
Subject(s)
Antineoplastic Agents, Hormonal/administration & dosage , Endometrium/pathology , Gonadotropin-Releasing Hormone/agonists , Leiomyoma/pathology , Leuprolide/administration & dosage , Uterine Neoplasms/pathology , Adult , Endometrium/drug effects , Endometrium/ultrastructure , Female , Humans , Leiomyoma/drug therapy , Leiomyoma/ultrastructure , Microscopy, Electron, Scanning , Microscopy, Electron, Transmission , Middle Aged , Uterine Neoplasms/drug therapy , Uterine Neoplasms/ultrastructureABSTRACT
PURPOSE: We present a case of ectopic pregnancy occurring in the stump of a remnant fallopian tube following ipsilateral adnexectomy for a mature cystic teratoma. METHODS: She had a laparoscopic salpingectomy. RESULTS: We hypothesize the intrauterine transmigration of the fecundated ovum. CONCLUSIONS: The authors emphasize the rarity of the observed case.
