Management of pseudohypoparathyroidism in pregnancy: a case report

Ramallo, Paula Guedes; Carreño, Evangelina Boix

doi:10.1080/01443615.2016.1250733

Cited by 3 publications

(6 citation statements)

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“…Giving the minimum effective dose of calcium, the main target of the therapy was to avoid both maternal hyper/hypocalcaemia and adverse effects on the development and function of foetal parathyroid glands. According to the cases described by O'Donnel et al [1], Ghershberg et al [6], Singh et al [7], Ochiai et al [8], Saito and Saito [9], our patient required calcium dosage implementation during third trimester because of maternal hypocalcaemia; conversely, Guedes Ramallo et al [4] and Seki et al [5] reported cases in which the level of calcium was maintained normal for all the duration of pregnancy. In our experience vitamin D remained stable since the beginning of gestation, in accordance with the findings of Guedes Ramallo et al [4] and Ochiai et al [8].…”

Section: Php 1b In Pregnancymentioning

confidence: 57%

“…Patients affected by PHP type 1a present varying degrees of Albright's hereditary osteodystrophy (AHO) features, a typical phenotype characterized by a round face, short stature, skeletal abnormalities, obesity, heterotopic calcifications, and developmental delay [3]. Patients with PHP type 1b shows isolated PHT resistance, without AHO [4]. There is scant literature available for PHP in pregnancy, with only one case reported of PHP type 1b [5], four cases of PHP type 1 a [4,[6][7][8], one case of PHP type 2 [9] and three cases of unspecified PHP [1,10].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with PHP type 1b shows isolated PHT resistance, without AHO [4]. There is scant literature available for PHP in pregnancy, with only one case reported of PHP type 1b [5], four cases of PHP type 1 a [4,[6][7][8], one case of PHP type 2 [9] and three cases of unspecified PHP [1,10]. PHP management is challenging in pregnancy, in order to maintain maternal normocalcemia while providing an adequate calcium supply to the foetus.…”

Section: Introductionmentioning

confidence: 99%

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Successful management of Pseudohypoparathyroidism Type 1b in pregnancy: a case report

Vidiri¹,

Marcantonio²,

Giorgi³

et al. 2023

It Journ Gyn Obs

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Background. Pseudohypoparathyroidism (PHP) refers to broad spectrum of genetic diseases characterized by the peripheral resistance to parathormone (PTH). This condition leads to hypocalcaemia, hyperphosphatemia and elevated PTH concentrations. There is scant literature on PHP in pregnancy, only nine cases published. The treatment of the disease in pregnant women is challenging. The main target is to avoid hyper/hypocalcaemia in order to prevent maternal adverse effects and to protect the development of the foetal parathyroid glands. Case presentation. We report a rare case of PHP type 1b in a pregnant woman, managed by a multidisciplinary team and treated with a tailored therapy. Conclusions. Good compliance with therapy, regular biochemical and clinical monitoring, and a multidisciplinary management are probably the best way to manage this condition in pregnancy.

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Section: Php 1b In Pregnancymentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Successful management of Pseudohypoparathyroidism Type 1b in pregnancy: a case report

Vidiri¹,

Marcantonio²,

Giorgi³

et al. 2023

It Journ Gyn Obs

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“…We had retrieved only one case report describing calcium homeostasis in PHP patients during the lactation period, which showed a stable serum calcium level and medicine dosage in a PHP1a patient with calcitriol 0.5 μg/day and calcium carbonate 2,500 mg/day (1,000 mg elemental calcium). The PTH level was not described ( 8 ). Since the elemental calcium intake was similar among the two patients in the present study and the patient in a previous case report, there should be other factors that influence calcium metabolism.…”

Section: Discussionmentioning

confidence: 99%

“…The data regarding mineral homeostasis in PHP patients during lactation are extremely rare. Only one case report published in 2017 was found ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Pseudohypoparathyroidism during pregnancy and the postpartum period: A case series of five patients

et al. 2022

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ObjectivesPseudohypoparathyroidism (PHP) is a rare disease, especially when combined with pregnancy. We aimed to explore the changes in serum calcium/parathyroid hormone (PTH) level and medical treatment in a case series of PHP during pregnancy and the postpartum period.MethodsA total of five PHP patients with six pregnancies were enrolled. The classification of PHP was based on (epi)genetic analysis. Clinical characteristics, biochemical indices, and treatment strategies before, during, and after pregnancy were retrospectively collected.ResultsAll patients received calcium and vitamin D agents with nearly normal serum calcium before pregnancy except patient 2 who was found hypocalcemic during gestation. All patients chose Cesarean section, and one suffered preterm delivery due to oligoamnios. The neonatal birth weight ranged from 2,250 to 4,300 g, and all neonates were free of hypocalcemia-related symptoms. The change in calcium metabolism was inconsistent including stable, improved, or worsened during pregnancy. Serum PTH level remained low in the first two trimesters in patients with stable and improved conditions while increased in the last two trimesters in patients with a worsened condition. Serum calcium changed inconsistently while PTH increased consistently during lactation. For patients who did not breastfeed, calcium homeostasis improved after delivery.ConclusionCalcium homeostasis and medicine dosage changed differently in PHP patients during pregnancy and lactation. However, most patients had good pregnancy outcomes. Serum PTH levels might predict changes in calcium metabolism during pregnancy.

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Hypoparathyroidism and pseudohypoparathyroidism in pregnancy: an Italian retrospective observational study

Marcucci

Altieri

Benvenga

et al. 2021

Orphanet J Rare Dis

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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 (followed between 2005 and 2018) with HypoPT (n = 25, 84% postsurgical, 16% idiopathic/autoimmune) and pseudo-HypoPT (n = 3). In HypoPT women, the mean calcium carbonate dose tended to increase gradually from the first to third trimester (+ 12.6%) in pregnancy. This average increase in the third trimester was significantly greater compared to the pre-pregnancy period (p value = 0.03). However, analyzing the individual cases, in 44% the mean calcium dosage remained unchanged throughout gestation. Mean calcitriol doses tended to increase during pregnancy, with a statistically significant increase between the third trimester and the pre-pregnancy period (p value = 0.02). Nevertheless, analyzing the individual cases, in the third trimester most women with HypoPT (64%) maintained the same dosage of calcitriol compared to the first trimester. Both mean calcium carbonate and calcitriol doses 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, 24 h urinary calcium, 25-OH vitamin D, and creatinine clearance. To avoid complications in mothers affected by (HypoPT) or (pseudo-HypoPT) and offspring, intense biochemical, clinical and pharmacological monitoring during pregnancy and breastfeeding is highly recommended.

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Management of pseudohypoparathyroidism in pregnancy: a case report

Cited by 3 publications

References 5 publications

Successful management of Pseudohypoparathyroidism Type 1b in pregnancy: a case report

Successful management of Pseudohypoparathyroidism Type 1b in pregnancy: a case report

Pseudohypoparathyroidism during pregnancy and the postpartum period: A case series of five patients

Hypoparathyroidism and pseudohypoparathyroidism in pregnancy: an Italian retrospective observational study

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