Primary hyperparathyroidism in pregnancy leading to hypercalcaemic crisis and uraemic encephalopathy

Nash, Ernest; Ranka, Poornima; Tarigopula, Giridhar; Rashid, Thomas

doi:10.1136/bcr-2014-208829

Cited by 14 publications

(17 citation statements)

References 21 publications

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“…PTH levels are associated with the degree of renal impairment in PHPT [ 132 ], and PTX prevents further kidney impairment [ 133 ]. CKD and related complications are seen also in other forms of hyperparathyroidism (e.g., multiple endocrine neoplasia type 1 (MEN1), type 2A (MEN2A), and type 4 (MEN4), parathyroid carcinoma, and gestational hyperparathyroidism) [ 102 , 134 , 135 , 136 ].…”

Section: Evidence For a Role Of Pth In Conditions Of Abnormal Pth mentioning

confidence: 99%

Physical Activity-Dependent Regulation of Parathyroid Hormone and Calcium-Phosphorous Metabolism

Lombardi

Ziemann²,

Banfi

et al. 2020

IJMS

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Exercise perturbs homeostasis, alters the levels of circulating mediators and hormones, and increases the demand by skeletal muscles and other vital organs for energy substrates. Exercise also affects bone and mineral metabolism, particularly calcium and phosphate, both of which are essential for muscle contraction, neuromuscular signaling, biosynthesis of adenosine triphosphate (ATP), and other energy substrates. Parathyroid hormone (PTH) is involved in the regulation of calcium and phosphate homeostasis. Understanding the effects of exercise on PTH secretion is fundamental for appreciating how the body adapts to exercise. Altered PTH metabolism underlies hyperparathyroidism and hypoparathyroidism, the complications of which affect the organs involved in calcium and phosphorous metabolism (bone and kidney) and other body systems as well. Exercise affects PTH expression and secretion by altering the circulating levels of calcium and phosphate. In turn, PTH responds directly to exercise and exercise-induced myokines. Here, we review the main concepts of the regulation of PTH expression and secretion under physiological conditions, in acute and chronic exercise, and in relation to PTH-related disorders.

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Section: Evidence For a Role Of Pth In Conditions Of Abnormal Pth mentioning

confidence: 99%

Physical Activity-Dependent Regulation of Parathyroid Hormone and Calcium-Phosphorous Metabolism

Lombardi

Ziemann²,

Banfi

et al. 2020

IJMS

View full text Add to dashboard Cite

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“…Nonetheless, it should be kept in mind that intravenous zoledronic acid, a therapeutic option for acute symptomatic hypercalcaemic crisis, is not recommended when eGFR is below 30 mL/min. 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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“…In this case, our woman had a history of nephrolithiasis, hyperemesis, chronic constipation and hypercalcaemia detected on previous bloods, suggesting the disease predated her pregnancy. It is not uncommon for women to remain undiagnosed and present late in pregnancy with complications 2 12. An earlier work up and treatment may have prevented or reduced the severity of these pregnancy complications.…”

Section: Discussionmentioning

confidence: 99%

Hyperparathyroidism in pregnancy

Davis

Nippita

2020

BMJ Case Rep

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Hyperparathyroidism is a rare disease during pregnancy, which has increased risks, including miscarriage and fetal growth restriction. However, the diagnosis of hyperparathyroidism is frequently not recognised or delayed as symptoms are non-specific and calcium is not routinely measured. With a thorough medical history and clinical suspicion, early diagnosis and treatment can reduce the risk of some pregnancy complications. A 35-year-old woman presented at 13/40 with hyperemesis gravidarum. She had elevated serum calcium and a parathyroid lesion on ultrasound. She underwent a parathyroidectomy with rapid normalisation of her calcium. Histopathology confirmed a parafibromin-deficient parathyroid tumour, suggestive of hyperparathyroidism jaw tumour syndrome. At 30/40, she presented with pre-eclampsia (hypertension, hyper-reflexia, proteinuria and intrauterine growth restriction) and had a caesarean section at 30+1/40, delivering a male infant, 897 g (fifth percentile). She had a prior 12-month history of chronic constipation and nephrolithiasis but was not investigated further despite elevated calcium (2.82 mmol/L).

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Primary hyperparathyroidism in pregnancy leading to hypercalcaemic crisis and uraemic encephalopathy

Cited by 14 publications

References 21 publications

Physical Activity-Dependent Regulation of Parathyroid Hormone and Calcium-Phosphorous Metabolism

Physical Activity-Dependent Regulation of Parathyroid Hormone and Calcium-Phosphorous Metabolism

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

Hyperparathyroidism in pregnancy

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