Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management

Ali, Dalal S.; Dandurand, Karel; Khan, Aliya

doi:10.3390/jcm10132956

Cited by 22 publications

(26 citation statements)

References 100 publications

(143 reference statements)

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“…Patient education and maintaining good hydration are important measures. ( 103 ) Most experts recommend PTX after the patient has delivered. If another pregnancy is desired, then the recommendation for PTX before the next pregnancy is even stronger.…”

Section: Guidelines For Surgery In Patients Followed Without Surgerymentioning

confidence: 99%

Management of Primary Hyperparathyroidism

Bilezikian

Silverberg

Bandeira

et al. 2020

Journal of Bone and Mineral Research

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Since the last international guidelines were published in 2014 on the evaluation and management of primary hyperparathyroidism (PHPT), new information has become available with regard to evaluation, diagnosis, epidemiology, genetics, classical and nonclassical manifestations, surgical and nonsurgical approaches, and natural history. To provide the most current summary of these developments, an international group, consisting of over 50 experts in these various aspects of PHPT, was convened. This paper provides the results of the task force that was assigned to review the information on the management of PHPT. For this task force on the management of PHPT, two questions were the subject of systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The full report addressing surgical and nonsurgical management of PHPT, utilizing the GRADE methodology, is published separately in this series. In this report, we summarize the results of that methodological review and expand them to encompass a much larger body of new knowledge that did not specifically fit the criteria of the GRADE methodology. Together, both the systematic and narrative reviews of the literature, summarized in this paper, give the most complete information available to date. A panel of experts then considered the last set of international guidelines in light of the newer data and assessed the need for their revision. This report provides the evidentiary background to the guidelines report. In that report, evidence from all task forces is synthesized into a summary statement and revised guidelines for the evaluation and management of PHPT. © 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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Section: Guidelines For Surgery In Patients Followed Without Surgerymentioning

confidence: 99%

Management of Primary Hyperparathyroidism

Bilezikian

Silverberg

Bandeira

et al. 2020

Journal of Bone and Mineral Research

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“…Several adverse maternal and fetal outcomes are associated with PHPT in pregnancy. Mothers can present with nephrolithiasis, hyperemesis gravidarum, and, in severe cases, acute pancreatitis ( 86 ), pre-eclampsia, miscarriages, intrauterine growth retardation, and premature delivery ( 3 , 18 , 85 ). These complications seem to be directly related to calcium levels, especially when calcium is 1 mg/dL above the upper normal limit ( 18 , 85 ).…”

Section: Special Conditionsmentioning

confidence: 99%

“…Surgery can be safely performed in the second trimester ( 3 ), and it should be a MIP guided by localization exams and IO-PTH ( 18 ). Fetal mortality in medically treated pregnant women was estimated to be one in five fetuses (16%), while fetal mortality and morbidity in those who were treated surgically for PHPT were estimated to be 3% and 10%, respectively, according to case reports from 1930 to 1990 ( 86 ). Older literature is believed to represent more severe cases of PHPT in pregnancy with worse outcomes ( 87 ).…”

Section: Special Conditionsmentioning

confidence: 99%

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Surgery for primary hyperparathyroidism

Neves¹,

Santos²,

Ohe³

2022

Archives of Endocrinology and Metabolism

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Primary hyperparathyroidism (PHPT) is a hypercalcemic disorder that occurs when one or more parathyroid glands produces excessive parathyroid hormone (PTH). PHPT is typically treated with surgery, and it remains the only definitive therapy, whose techniques have evolved over previous decades. Advances in preoperative localization exams and the intraoperative PTH monitoring have become the cornerstones of recent parathyroidectomy techniques, as minimally invasive techniques are appropriate for most patients. Nevertheless, these techniques, are not suitable for PHPT patients who are at risk for multiglandular disease, especially in those who present with familial forms of PHPT that require bilateral neck exploration. This manuscript also explores other conditions that warrant special consideration during surgical treatment for PHPT: normocalcemic primary hyperparathyroidism, pregnancy, reoperation for persistent or recurrent PHPT, parathyroid carcinoma, and familial and genetic forms of hyperparathyroidism.

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“…Hyperemesis gravidarum may indeed mask hypercalcemia symptoms while calcium levels are seldom elevated because of pregnancy physiological modifications (haemodilution, hypoalbuminemia, maternal hypercalciuria and high foetal calcium demand, amongst others) [ 3 ]. In pregnancy, symptoms may even be more occult with the possibility of severe events such as pre-eclampsia and hypercalcaemic crisis, not to mention foetal complications [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

A Fatal Case of Metastatic Pulmonary Calcification during the Puerperium

Chighine

Corona

Catani

et al. 2022

IJMS

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We present an unusual case of a fatal respiratory failure in a young woman developed two weeks after she gave birth at home. Circumstantial and clinical features of the case were strongly suggestive for a ‘classical’ septic origin of the respiratory symptoms. Autopsy, together with histopathological and immunohistochemical analyses allowed demonstrating a massive calcium redistribution consisting of an important osteolysis, especially from cranial bones and abnormal accumulation in lungs and other organs. Such physiopathology was driven by a primary hyperparathyroidism secondary to a parathyroid carcinoma as demonstrated by immunohistochemistry. This very rare case is furthermore characterised by a regular pregnancy course, ended with the birth of a healthy new-born. A complex interaction between pregnancy physiology and hyperparathyroidism might be hypothesised, determining the discrepancy between the relative long period of wellness and the tumultuous cascade occurred in the puerperium.

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Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management

Cited by 22 publications

References 100 publications

Management of Primary Hyperparathyroidism

Management of Primary Hyperparathyroidism

Surgery for primary hyperparathyroidism

A Fatal Case of Metastatic Pulmonary Calcification during the Puerperium

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