Parathyroid Function and Disease during Pregnancy, Lactation, and Fetal/Neonatal Development

Kovacs, Christopher S.

doi:10.1016/b978-0-12-397166-1.00063-1

Cited by 1 publication

(3 citation statements)

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“…Given the significant overlap of renal calcium indices in normal, FHH, and PHPT patients [2] and the variable effect of changes in maternal calcium handling during pregnancy and lactation on renal calcium indices, the CCCR is even more difficult to interpret during these reproductive stages than outside pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is significant overlap of renal calcium indices such as the CCCR in normal, FHH, and PHPT patients [2]. Despite this, CCCR is used in conjunction with clinical features and genetic testing when required to distinguish between FHH and PHPT outside of pregnancy.…”

Section: Diagnosismentioning

confidence: 99%

“…Parathyroidectomy is definitive therapy for patients with symptomatic PHPT but is inappropriate in those with FHH. This is because patients with FHH have a loss of function or inactivating mutation in the gene for the calcium sensing receptor (CaSR), leading to hypercalcemia starting in fetal life [2]. Although these patients have calcium levels above the reference range for the population, their degree of hypercalcemia reflects a higher set point for a physiological level of calcium; that is, they require a higher calcium level to maintain neurological, muscular, and other cellular functions.…”

Section: Introductionmentioning

confidence: 99%

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The Biochemical Profile of Familial Hypocalciuric Hypercalcemia and Primary Hyperparathyroidism during Pregnancy and Lactation: Two Case Reports and Review of the Literature

Ghaznavi

Saad

Donovan

2016

Case Reports in Endocrinology

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Background. Primary hyperparathyroidism (PHPT) and Familial Hypocalciuric Hypercalcemia (FHH) result in different maternal and fetal complications in pregnancy. Calcium to creatinine clearance ratio (CCCR) is commonly used to help distinguish these two conditions. Physiological changes in calcium handling during pregnancy and lactation can alter CCCR, making it a less useful tool to distinguish PHPT from FHH. Cases. A 25-year-old female presented with hypercalcemia and an inappropriately normal PTH. Her CCCR was 0.79% before pregnancy and rose to 1.99% in her second trimester. The proband's mother and neonate had asymptomatic hypercalcemia. Genetic analysis revealed a CaSR mutation consistent with FHH. A 19-year-old female presented with a history of nephrolithiasis who underwent emergent caesarean section at 29 weeks of gestation for severe preeclampsia. At delivery, she was diagnosed with hypercalcemia with an inappropriately normal PTH and a CCCR of 2.67%, which fell to 0.88% during lactation. Parathyroidectomy cured her hypercalcemia. Pathology confirmed a parathyroid adenoma. Conclusion. These cases illustrate the influence of pregnancy and lactation on renal calcium indices, such as the CCCR. To avoid diagnostic error of women with hypercalcemia during pregnancy and lactation, calcium biochemistry of first-degree relatives and genetic testing of select patients are recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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