Pregnancy Outcomes in Women With Primary Hyperparathyroidism

Hirsch, Dania; Kopel, Vered; Nadler, Varda; Levy, Sigal; Toledano, Yoel; Tsvetov, Gloria

doi:10.1210/jc.2015-1110

Cited by 92 publications

(108 citation statements)

References 25 publications

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“…found that it occurred in 0.03% of reproductive age women who underwent routine screening of serum calcium (391). Several hundred cases have been described in English-language medical journals (354,391,466), while the author's advice has been sought for several cases each year by clinicians around the globe.…”

Section: Mineral Metabolism During Pregnancy and Lactationmentioning

confidence: 99%

“…Several hundred cases have been described in English-language medical journals (354,391,466), while the author's advice has been sought for several cases each year by clinicians around the globe. Primary hyperparathyroidism is 10 -20 times more likely to occur in women over age 45 than in women of child-bearing age (373,980), but in two case series, ϳ1% of all parathyroidectomies were done in pregnant women (466,490).…”

Section: Mineral Metabolism During Pregnancy and Lactationmentioning

confidence: 99%

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Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

359

524

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During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ϳ30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

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Section: Mineral Metabolism During Pregnancy and Lactationmentioning

confidence: 99%

Section: Mineral Metabolism During Pregnancy and Lactationmentioning

confidence: 99%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

359

524

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“…Denosumab might represent an alternative to bisphosphonates in controlling severe hypercalcaemia as (69). In a recent series of 74 mild PHPT women aged 20-40 years who experienced pregnancy, kidney stones were reported in 12% of patients (70).…”

Section: Effects Of Bisphosphonates On Kidney Functionmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects

Verdelli

Corbetta

2017

European Journal of Endocrinology

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Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. Kidney is a target of both chronic elevated PTH and calcium in PHPT. The classic PHPT complications of symptomatic kidney stones and nephrocalcinosis have become rare and the PHPT current presentation is asymptomatic with uncertain and long-lasting progression. Nonetheless, the routine use of imaging and of biochemical determinations have revealed the frequent occurrence of asymptomatic kidney stones, hypercalciuria and reduced kidney function in asymptomatic PHPT patients. Though the pathogenesis is far from being elucidated, PHPT is associated with reduced renal function, in terms of estimated glomerular filtration rate, and related increased morbidity and mortality. In the last decade, the effort of the Kidney Disease: Improving Global Outcomes (KDIGO) panel of experts highlighted that even mild reduction of kidney function is associated with increased risk of cardiovascular disease. These considerations provided the basis for the Fourth Workshop recommendations of a more extensive diagnostic workout about kidney features and of wider criteria for parathyroid surgery including asymptomatic kidney disease. Moreover, kidney involvement in PHPT is likely to be affected by variants of genes coding the key molecules regulating the calcium and ions renal handling; these features might have clinical relevance and should be considered both during diagnostic workout and follow-up. Finally, the effects of parathyroid surgery and of medical treatment on kidney involvement of PHPT are reviewed.

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“…Hypercalcemia in pregnancy is uncommon, occurring in approximately 0.03% of women of reproductive age 1. The condition is probably underdiagnosed due to its nonspecific symptomalogy and the physiological decrease in total calcium accompanying lower albumin levels.…”

Section: Discussionmentioning

confidence: 99%

“…The main cause of hypercalcemia in pregnancy is primary hyperparathyroidism (PHPT) 1, 9. Most of the data in the literature on hypercalcemia in pregnancy come from women with PHPT.…”

Section: Discussionmentioning

confidence: 99%

Hypercalcemia in pregnancy – a multifaceted challenge: case reports and literature review

Rey

Jacob

Koolian

et al. 2016

Clinical Case Reports

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Pregnancy Outcomes in Women With Primary Hyperparathyroidism

Abstract: Serum calcium levels are usually only mildly elevated during pregnancy in women with PHPT. A significant proportion of cases go undiagnosed. Mild hypercalcemia in gestational PHPT is generally not associated with an increased risk of obstetrical complications.

Cited by 92 publications

References 25 publications

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

MECHANISMS IN ENDOCRINOLOGY: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects

Hypercalcemia in pregnancy – a multifaceted challenge: case reports and literature review

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