Hyperparathyroidism in Pregnancy: Options for Localization and Surgical Therapy

• Published in: World journal of surgery Vol. 34; no. 8; pp. 1811 - 1816
• Main Authors: McMullen, Todd P. W., Learoyd, Diana L., Williams, David C., Sywak, Mark S., Sidhu, Stan B., Delbridge, Leigh W.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.08.2010; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Biological and medical sciences; Cardiac Surgery; Endocrine; Endocrinopathies; Female; Fetal Death; General aspects; General Surgery; Head and Neck; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - surgery; Infant, Newborn; Medical sciences; Medicine; Medicine & Public Health; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - surgery; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Pregnancy; Pregnancy Complications - diagnostic imaging; Pregnancy Complications - surgery; Pregnancy Outcome; Premature Birth; Radionuclide Imaging; Radiopharmaceuticals; Surgery; Technetium Tc 99m Sestamibi; Thoracic Surgery; Vascular Surgery; Endocrine; Head and Neck; Endocrinopathy; Pregnancy; Human; Medicine; Treatment; Parathyroid diseases; Surgery; Female; Woman; Localization; Hyperparathyroidism
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0569-2

Background Hyperparathyroidism in pregnancy is a threat to the health of both mother and fetus. The mothers suffer commonly from nephrolithiasis, hyperemesis, or even hypercalcemic crisis. Untreated disease will commonly complicate fetal development and fetal death is a significant risk. Treatment options, including medical and surgical therapy, are debated in the literature. Methods This is a case series comprising seven patients with primary hyperparathyroidism in pregnancy. Data collected included symptoms at diagnosis, biochemical abnormalities, pathologic findings, treatment regimes, and subsequent maternal and fetal outcomes. Results Seven women, aged 20 to 39 years, presented with hyperparathyroidism during pregnancy. The earliest presented at 8 weeks and the latest at 38 weeks. Four of seven patients experienced renal calculi. Calcium levels were 2.7–3.5 mmol/l. All were found to have solitary parathyroid adenomas, of which two were in ectopic locations. Fetal complications included three preterm deliveries and one fetal death with no cases of neonatal tetany. Maternal and fetal complications could not be predicted based on duration or severity of hypercalcemia. Three patients were treated during pregnancy with surgery, and two of these had ectopic glands that required reoperations with a novel approach using Tc-99m sestamibi scanning during pregnancy to assist in localizing the abnormal gland. Four cases were treated postpartum with a combination of open and minimally invasive approaches after localization. No operative complications or fetal loss related to surgery were observed in this cohort. Conclusions Primary hyperparathyroidism in pregnancy represents a significant risk for maternal and fetal complications that cannot be predicted by duration of symptoms or serum calcium levels. Surgical treatment should be considered early, and a minimally invasive approach with ultrasound is best suited to mitigating risk to mother and fetus. Equally important, Tc-99m sestamibi imaging may be used safely for localization of the parathyroids after negative cervical explorations.