Endocrine Abstracts

Background: The management of Primary hyperparathyroidism (PHPT) during pregnancy is challenging due to lack of robust guidelines. Various studies have suggested an increased risk of various maternal and foetal complications, however there is no clear consensus in the literature about medical treatment vs surgery during pregnancy. The aim of this study was to review the maternal and foetal outcomes of pregnant women treated for PHPT at a single tertiary care centre and compare our findings with similar studies in the literature.

Methods: Data on relevant clinical parameters, demographics, management strategies, maternal and foetal outcomes were collected from pregnant patients with PHPT between 2012 and 2019.

Results: Of 15 pregnancies with PHPT that were reviewed, 6 were managed medically and 9 patients underwent surgery during pregnancy. The median age at index pregnancy was 28 years (range 19–42). The median highest recorded adjusted calcium in the medical group was 2.90 mmol/l (2.61–3.25) while it was 3.11 mmol/l (2.78–4.95) in the surgical group. There was one miscarriage and stillbirth of a twin pregnancy in the medical group, but none in the surgical group. The median gestational age at delivery (excluding miscarriage) was 39 + 3 (24 + 2–41 + 2) and 39 + 4 (37 + 1–39 + 5) in the medical and surgical groups respectively. There was one emergency C-section in each group. None of the live births in either groups were complicated with neonatal tetany or convulsions. All the surgeries were successful with no reported post-operative complications.

Conclusion: This study and the review current literature suggests that more complications appear to occur in the medically treated pregnant PHPT patients, however the evidence is not conclusive. Most surgeries during pregnancy are performed during the second trimester with good outcomes. Multi-centre prospective studies are required to ascertain the exact risk of various complications for PHPT during pregnancy.