Endocrine Abstracts

Background: Primary hyperparathyroidism (PHPT) during pregnancy is rare and often unrecognized. Most of these patients are asymptomatic or have nonspecific complaints but some of them сan present with classical symptoms of PHPT and even with severe complications of pregnancy as preeclampsia, miscarriage, preterm labor etc. The incidence of maternal complications is approximately 67%, poor fetal outcomes, including stillbirth and intrauterine growth retardation may reach 80%. Therefore, PHPT in pregnancy requires close monitoring of the multidisciplinary team.

Aim: We present a case series of PHPT in pregnancy.

Results: We managed 15 young women (median age 32 [28; 37] years), who were referred to our Centre at 21 [17; 24] weeks gestation (min 16, max 34) and only one in the early postpartum period. Two of them had MEN1 mutation. The main laboratory features of PHPT were: iPTH 133.1 pg/ml [84.5; 232.7], albumin-adjusted serum calcium 2.87 mmol/l [2.74; 2.90], 24-h urinary calcium 10.8 mmol [6.3; 12.8]. The most common PHPT complication was nephrolithiasis (67%), among non-classical complications - hypertension (13%) and gestational diabetes (20%). 6 women received conservative treatment (group 1), because of mild disease (n=3), patient’s withdrawal (n=1) or high risks of preterm labor (n=2), and 9 people (group 2) underwent parathyroidectomy (PTE). The calcium and iPTH levels were comparable in both groups (for all P>0.05). A conservative management in all cases included low-calcium diet and oral rehydration. One patient from group 1 received cinacalcet 30 mg for 4 weeks before delivery and another one from group 2 for 2 weeks before PTE with a positive effect on serum calcium level in both cases. One patient underwent emergency C-section because of preeclampsia. In all cases a selective PTE was performed at 22 [18; 25] weeks followed by parathyroid adenoma confirmation. The total frequency of fetal/newborn complications was 50% in the group 1 and 22% in the group 2, among them hypocalcemia (n=1), congenital pneumonia (n=2), intrauterine fetal death in twins (n=1) were observed. In a single case (group 2) after successful PTE surgical abortion was carried out at 21 weeks gestation because congenital heart defect had been detected.

Conclusion: Surgical approach seems more beneficial for pregnant patients with symptomatic PHPT. PTE performed during the second trimester resulted in good outcomes. Mild forms of the disease can be managed conservatively with low-calcium diet and optimal oral hydration.