Life-Threatening Hypercalcemia Associated With Primary Hyperparathyroidism During Pregnancy: Case Report And Review Of Literature

Iqbal, Nayyar; Aldasouqi, Saleh; Mohammed, Ibrahim Aboulfotoh; Edmondson, James W.

doi:10.4158/ep.5.6.337

Cited by 16 publications

(18 citation statements)

References 41 publications

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“…The existing literature describing the consequences of gestational PHPT is limited, and mainly consists of case reports or case series (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28). In total, these studies reported 33 pregnancies in women with PHPT, who did not undergo surgery.…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy outcomes in women with primary hyperparathyroidism

Abood

Vestergaard

2014

European Journal of Endocrinology

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Objective: To study pregnancy and pregnancy outcomes in women with primary hyperparathyroidism (PHPT) and in controls. Design: Register-based retrospective cohort study of women aged 16-44 years with a diagnosis of PHPT with age-and gender-matched non-exposed controls in Denmark. Methods: The patients and controls were identified using the Danish National Hospital Discharge Register for the period 1977-2010. The outcomes were determined using the Birth Register, the Abortion Register and the LPR (National Hospital Discharge Register). The primary outcome was the relative risk of abortions in patients compared with controls. Results: A total of 1057 women with PHPT and 3171 controls were identified. The number of women giving birth and experiencing abortions did not differ between the two groups (live births, PZ0.21 and abortions, PZ0.12). Also birth weight, length, Apgar score, and gestation length at abortion did not differ. Within the first year after the diagnosis was made, gestation length was lower in women with PHPT than that in controls. However, this was linked to more deliveries by caesarian sections. Conclusions: A diagnosis of PHPT did not seem to increase the rate of abortions in our study. Reducing the abortion risk may therefore not be an indication for parathyroidectomy during pregnancy in patients with mild PHPT. The PHPT diagnosis does not seem to affect birth weight, length and Apgar score. The higher number of deliveries by cesarean section after the diagnosis was made may be associated with lower gestation age. The strategy for delivery should be carefully considered in pregnant women with PHPT.

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Section: Discussionmentioning

confidence: 99%

“…Primary hyperparathyroidism (PHPT) ranks third among the most common endocrine disorders after diabetes mellitus and thyroid disease, but it occurs rarely during pregnancy (1,2,3). This can in part be attributed to the fact that PHPT most commonly occurs after the childbearing years.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in women with primary hyperparathyroidism

Abood

Vestergaard

2014

European Journal of Endocrinology

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“…However, it rarely occurs during pregnancy (1)(2)(3). Gestational PHPT may have serious consequences for both mother and fetus (4 -7).…”

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confidence: 99%

Pregnancy Outcomes in Women With Primary Hyperparathyroidism

Hirsch

Kopel

Nadler

et al. 2015

The Journal of Clinical Endocrinology & Metabolism

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“…If untreated, hypercalcemia is associated with an increased risk of maternal and fetal morbidity, and several cases of hypercalcemic crisis have been reported [22][23][24][25][26] (Table 1). Persistent maternal hypercalcemia suppresses the development of the fetal parathyroid glands.…”

Section: Primary Hyperparathyroidismmentioning

confidence: 99%

Hypercalcemia during Pregnancy, Puerperium, and Lactation: Review and a Case Report of Hypercalcemic Crisis after Delivery Due to Excessive Production of PTH-related Protein (PTHrP) without Malignancy (Humoral Hypercalcemia of Pregnancy)

Sato

2008

Endocr J

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Abstract. Hypercalcemia during pregnancy or after delivery is uncommon, and mostly associated with primary hyperparathyroidism (PHPT). If unrecognized, it may increase maternal and fetal morbidity. In a very few patients with PHPT, hypercalcemic crisis develops during pregnancy and particularly after delivery, since calcium transport from the mother to the fetus is abruptly disrupted. Hypercalcemia may also develop in pregnant women due to PTH-related protein (PTHrP)-producing malignant tumors (humoral hypercalcemia of malignancy). Since PTHrP is produced physiologically in fetal and maternal tissues, hypercalcemia may occasionally develop during pregnancy, puerperium, and lactation due to excessive production of PTHrP in the placenta and/or mammary glands. PTHrP may also be involved in milk-alkali syndrome that develops during pregnancy. Although non-malignant hypercalcemia is usually mild, we report a 28-yearsold pregnant woman who developed hypercalcemic crisis after normal delivery of an infant. On the first postpartum day, the corrected serum calcium concentration increased to 19.4 mg/dl with a markedly increased serum level of PTHrP (28.4 pmol/L) (normal <1.1 pmol/L). After administration of saline and pamidronate, the serum levels of calcium and PTHrP rapidly normalized. Extensive examination revealed no malignant lesion, suggesting that the placenta may have been producing an excessive amount of PTHrP (humoral hypercalcemia of pregnancy). We review case reports of nonmalignant hypercalcemic crisis associated with pregnancy indexed in PubMed in which serum levels of intact PTH and/or PTHrP were described, and stress that rapid control of hypercalcemia is mandatory to save the life of the mother and the infant.

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Life-Threatening Hypercalcemia Associated With Primary Hyperparathyroidism During Pregnancy: Case Report And Review Of Literature

Cited by 16 publications

References 41 publications

Pregnancy outcomes in women with primary hyperparathyroidism

Pregnancy outcomes in women with primary hyperparathyroidism

Pregnancy Outcomes in Women With Primary Hyperparathyroidism

Hypercalcemia during Pregnancy, Puerperium, and Lactation: Review and a Case Report of Hypercalcemic Crisis after Delivery Due to Excessive Production of PTH-related Protein (PTHrP) without Malignancy (Humoral Hypercalcemia of Pregnancy)

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