Management of hypoparathyroidism in pregnancy and lactation — A report of 10 cases

Hatswell, B. L.; Allan, Carolyn; Teng, Jun; Wong, Phillip; Ebeling, PR; Wallace, Euan M.; Fuller, Peter J.; Milat, Frances

doi:10.1016/j.bonr.2015.05.005

Cited by 32 publications

(76 citation statements)

References 30 publications

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“…Nearly 30 g of calcium is transferred from mother to the fetus throughout pregnancy with maximum in the last trimester. 2,4 Thus, long-standing hypocalcemia in pregnancy is more likely to manifest in the peripartum period as evidenced in our case. Asymptomatic hypocalcemia in pregnancy is widely prevalent in India, 5 and regular monitoring of serum calcium and a calcium-rich diet in pregnancy is essential.…”

supporting

confidence: 56%

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Lip Tremor in Hypocalcemia

Kumar

Prakash

2020

JNRP

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Neuromuscular hyperexcitability (NH) resulting from hypocalcemia commonly manifests as facial twitching and perioral tingling. 1 Lip tremor in hypocalcemia has never been reported to the best of our knowledge. We report a postpartum female, with two previous miscarriages, presenting with seizures and lip tremor and diagnosed with hypocalcemia.A 23-year-old woman, 5 days postpartum with past history of two second-trimester miscarriages presented with new-onset generalized tonic-clonic seizures and lip tremor without fever, headache, or vomiting. Trousseau's and Chvostek's signs were positive, and neurological examination revealed a rhythmic, 8 to 10 Hz tremor involving upper lip (►Video 1). Computed tomography of the brain revealed bilateral basal ganglia, thalamus, subcortical white matter, red, and dentate nuclei calcification (►Fig. 1). Electroencephalogram was nonconclusive. Blood work-up revealed reduced calcium of 1.37 mmol/L (normal, 2.14-2.56), raised phosphate of 8.22 mg/dL (normal, 3-4.5), reduced parathyroid hormone of 4 pg/mL (normal, 12-88), and vitamin D of 9.55 ng/mL (normal, 10-55), thereby suggesting a diagnosis of idiopathic hypoparathyroidism. Gynecological and hematological investigations including anticardiolipin antibodies returned nonconclusive. We treated her initially with intravenous calcium gluconate followed by oral elemental calcium 2 g/d and calcitriol 1.5 g/d. Her symptoms including lip tremor subsided over subsequent 4 weeks (►Video 1).Hypocalcemia is common in pregnancy, mostly due to hypoparathyroidism and dietary deficiency. 2 Long-standing idiopathic hypoparathyroidism was the cause in our case. NH resulting from reduced extracellular calcium modulates various receptors and ion channels, 3 commonly manifesting as muscle spasms, cramps, twitchings, paresthesia, numbness, and seizure. 1 Lip tremor in our case appears related to NH.

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confidence: 56%

“…Letter to the Editor NH may increase uterine irritability leading to miscarriages, 4 as reported by our case. Nearly 30 g of calcium is transferred from mother to the fetus throughout pregnancy with maximum in the last trimester.…”

supporting

confidence: 54%

Lip Tremor in Hypocalcemia

Kumar

Prakash

2020

JNRP

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“…Until now, only limited case reports or case series of pregnant/lactating hypoparathyroid women have been published (1,20,22,24,(29)(30)(31)(32)(33). Among these, the largest case series described 12 cases with HypoPT (20,33), while for women with pseudo-hypoPT, only case reports are available (34)(35)(36)38).…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 99%

“…In our study, in most cases pregnancy was natural and full-term. On the other hand, the few cases preterm delivery (3/25 HypoPT women) may be due to inadequately controlled serum calcium concentration (mean serum calcium levels < 8 mg/dl in the third trimester), which increases uterine irritability (11,24,41). These 3 women also had maternal complications, such as gestational diabetes (n = 3), pre-eclampsia (n = 2), placenta previa (n = 1) and polyhydramnios (n = 1), that are unlikely to be related to HypoPT.…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 99%

“…During pregnancy, the challenge of pharmacological management is to maintain normal calcium and phosphate levels in both plasma and urine, periodically evaluating these markers and the variable individual responses to treatment (22)(23)(24)(25). Calcium and active vitamin D requirements can change dramatically during pregnancy, which may require frequent dose adjustments (11,22,26).…”

Section: Introductionmentioning

confidence: 99%

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Hypoparathyroidism and Pseudohypoparathyroidism in Pregnancy: An Italian Retrospective Observational Study

Marcucci

Altieri

Benvenga

et al. 2020

Preprint

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Background: Hypoparathyroidism (HypoPT) or pseudo-hypoparathyroidism (pseudo-HypoPT) during pregnancy may cause maternal and fetal/neonatal complications. In this regard, only a few case reports or case series of pregnant or lactating women have been published. The purpose of this study was to describe clinical and biochemical course, pharmacological management, and potential adverse events during pregnancy and post-partum in pregnant women with HypoPT or pseudo-HypoPT. This was a retrospective, observational, multicenter, study involving nine Italian referral centers for endocrine diseases affiliated with the Italian Society of Endocrinology and involved in “Hypoparathyroidism Working Group”.Results: This study identified a cohort of 28 women (between 2005 and 2018) with HypoPT (n=25, 80% postsurgical) and pseudo-HypoPT (n=3). The mean calcium carbonate and calcitriol doses of both groups were increased during pregnancy compared to pre-pregnancy period. During the three trimesters of pregnancy the mean calcium carbonate and calcitriol doses were variable, remaining unchanged throughout gestation respectively in 40% and 60% of women with HypoPT, whilst tended to decrease from the third trimester to the post-partum six months. Most identified women (~70%) did not display maternal complications and (~90%) maintained mean serum albumin-corrected total calcium levels within the low-to-mid normal reference range (8.5±0.8 mg/dl) during pregnancy. The main complications related to pregnancy period included: preterm birth (n=3 HypoPT women), and history of miscarriages (n=6 HypoPT women and n=2 pseudo-HypoPT women). Conclusion: This study shows that mean serum albumin-corrected total calcium levels were carefully monitored during pregnancy and post-pregnancy, with limited evaluation of other biochemical parameters, such as serum phosphate, 24h urinary calcium, 25-OH vitamin D, and creatinine clearance. To avoid complications in mothers and offspring, intense biochemical, clinical and pharmacological monitoring during pregnancy and breastfeeding is highly recommended.

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Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines from the Second International Workshop

Khan

Bilezikian

Brandi³

et al. 2020

Journal of Bone and Mineral Research

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This clinical practice guideline addresses the prevention, diagnosis, and management of hypoparathyroidism (HypoPT) and provides evidence‐based recommendations. The HypoPT task forces included four teams with a total of 50 international experts including representatives from the sponsoring societies. A methodologist (GG) and his team supported the taskforces and conducted the systematic reviews. A formal process following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and the systematic reviews provided the structure for seven of the guideline recommendations. The task force used a less structured approach based on narrative reviews for 20 non‐GRADEd recommendations. Clinicians may consider postsurgical HypoPT permanent if it persists for >12 months after surgery. To predict which patients will not develop permanent postsurgical HypoPT, we recommend evaluating serum PTH within 12 to 24 hours post total thyroidectomy (strong recommendation, moderate quality evidence). PTH > 10 pg/mL (1.05 pmol/L) virtually excludes long‐term HypoPT. In individuals with nonsurgical HypoPT, genetic testing may be helpful in the presence of a positive family history of nonsurgical HypoPT, in the presence of syndromic features, or in individuals younger than 40 years. HypoPT can be associated with complications, including nephrocalcinosis, nephrolithiasis, renal insufficiency, cataracts, seizures, cardiac arrhythmias, ischemic heart disease, depression, and an increased risk of infection. Minimizing complications of HypoPT requires careful evaluation and close monitoring of laboratory indices. In patients with chronic HypoPT, the panel suggests conventional therapy with calcium and active vitamin D metabolites as first‐line therapy (weak recommendation, low‐quality evidence). When conventional therapy is deemed unsatisfactory, the panel considers the use of PTH. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Management of hypoparathyroidism in pregnancy and lactation — A report of 10 cases

Cited by 32 publications

References 30 publications

Lip Tremor in Hypocalcemia

Lip Tremor in Hypocalcemia

Hypoparathyroidism and Pseudohypoparathyroidism in Pregnancy: An Italian Retrospective Observational Study

Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines from the Second International Workshop

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