Clinical Management of Hyperparathyroidism in Pregnancy

Clinical management of hyperparathyroidism in pregnancy demands a nuanced approach to maintain maternal calcium homoeostasis while safeguarding foetal development. Primary hyperparathyroidism is characterised by inappropriately elevated parathyroid hormone and resultant hypercalcaemia, leading to risks such as nephrolithiasis, pancreatitis, pre-eclampsia and intrauterine growth restriction. Physiological adaptations in gestation, including increased intestinal calcium absorption and placental calcium transfer, can mask symptom severity and complicate biochemical diagnosis; ionised calcium measurement is preferred over total serum calcium. Initial management centres on hydration, avoidance of loop diuretics and thiazides, and close monitoring of calcium and renal function. Medical therapies such as cinacalcet may be reserved for those unfit for surgery, although safety data remain limited. Surgical resection via minimally invasive parathyroidectomy in the second trimester is widely accepted as definitive treatment for severe or symptomatic disease. A multidisciplinary team involving endocrinologists, obstetricians and anaesthetists is essential for optimising timing of intervention and monitoring both maternal and foetal outcomes.

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Clinical Management of Hyperparathyroidism in Pregnancy publication trend

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Technical terms

Primary hyperparathyroidism: Excessive secretion of parathyroid hormone by one or more parathyroid glands leading to hypercalcaemia.

Hypercalcaemia: Elevated concentration of calcium in the blood, which may cause systemic complications.

Parathyroidectomy: Surgical removal of hyperfunctioning parathyroid tissue to normalise calcium levels.

Calcimimetic agent: Drug that mimics calcium to modulate parathyroid calcium-sensing receptors and suppress hormone release.

Ionised calcium: The physiologically active fraction of serum calcium, preferred for accurate assessment during pregnancy.

References

1. Clinical Presentation, Management, and Outcomes of Primary Hyperparathyroidism during Pregnancy. International Journal of Endocrinology (2017).
2. Primary Hyperparathyroidism in Pregnancy: Literature Review of the Diagnosis and Management. Journal of Clinical Medicine (2021).
3. The Biochemical Profile of Familial Hypocalciuric Hypercalcemia and Primary Hyperparathyroidism during Pregnancy and Lactation: Two Case Reports and Review of the Literature. Case Reports in Endocrinology (2016).