Parathyroidectomy in First Trimester of Pregnancy

Sonia G. Sharma; Steven N. Levine; Rajini K. Yatavelli; Manish A. Shaha; Cherie Ann O. Nathan

Disclosures

J Endo Soc. 2020;4(3) 

In This Article

Abstract and Introduction

Abstract

Primary hyperparathyroidism is not commonly diagnosed during pregnancy. For pregnant women with mild, asymptomatic disease, surgery can be avoided unless the degree of hypercalcemia becomes more severe or they develop complications. However, there are no evidence-based guidelines to assist clinicians regarding the management of primary hyperparathyroidism during pregnancy. When surgery is deemed necessary during pregnancy, the second trimester is generally considered to be the optimal time. We report the case of a 31-year-old female G1P0 who presented at 6 weeks gestation with symptoms of nausea, vomiting, polyuria, and corrected calcium of 14.8 mg/dL. Due to the extreme degree of hypercalcemia and refractory to medical treatment, it was decided that surgery could not be delayed until the second trimester. At 7w3d gestational age the patient had resection of a 37 gram, 5 × 4 × 3 cm right inferior parathyroid adenoma.

Introduction

Primary hyperparathyroidism is not commonly diagnosed during pregnancy.[1–2] For nonpregnant individuals the definitive treatment is surgery when there are significant elevations of the serum calcium or complications of the disease. For those with mild, asymptomatic disease, surgery can be avoided unless the degree of hypercalcemia becomes more severe or they develop complications.[3–6] There are published guidelines when surgery is recommended for men and nonpregnant patients with hyperparathyroidism.[4] Clearly, any decision regarding surgery for a pregnant woman with primary hyperparathyroidism is more complex than in men or nonpregnant women and there are no evidence-based guidelines to assist clinicians regarding the management of primary hyperparathyroidism during pregnancy.

Hypercalcemia during pregnancy has been associated with increased maternal and fetal morbidity and mortality. Maternal complications include nephrolithiasis, pancreatitis, hyperemesis gravidarum, preeclampsia, and hypercalcemic crises.[7,8] Maternal hypercalcemia also increases the risk of perinatal complications primarily due to an increased frequency of miscarriages and neonatal hypocalcemia and tetany.[2,7,9–11] When surgery is deemed necessary during pregnancy, the second trimester is generally considered to be the optimal time.[8,11,12]

We report the case of a 31-year-old female G1P0 who presented at 6 weeks gestation with symptomatic hypercalcemia and a corrected calcium of 14.8 mg/dL. Due to the extreme degree of hypercalcemia and refractory to medical treatment, it was decided that surgery could not be delayed until the second trimester. At 7w3d gestational age the patient underwent a parathyroidectomy.

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