Hyperparathyroidism and pregnancy

Background: Hyperparathyroidism during pregnancy can carry significant morbidity to both mother and fetus. Surgery is the definitive treatment of choice although medical management is occasionally warranted. This report looks at 6 cases of hyperparathyroidism during pregnancy and reviews the morbidity and mortality of this entity. Methods: We retrospectively reviewed all parathyroidectomies performed over a 21-year period (May 1975 to May 1996). A total of 750 cases were performed. In 6 cases, hyperparathyroidism occurred during pregnancy. Serum calcium was measured in all patients before and after parathyroidectomy. Results: A total of 6 of 750 patients (0.8%) were found to have hyperparathyroidism during pregnancy. In this review, fetal mortality rate was 17% (1 of 6). Two infants experienced neonatal tetany. Maternal morbidity included 1 woman who developed hypercalcemic crisis and acute pancreatitis. Two patients presented with hyperemesis gravidarum, 2 were asymptomatic, and 1 had recurrent urinary tract infection. Conclusion: Hyperparathyroidism during pregnancy, while rare, remains a preventable cause of fetal morbidity and mortality. Based on our case series and review of the literature, surgery is the definitive treatment of choice and is considered safe and effective if performed during the second trimester of pregnancy. Those involved with the care of the pregnant patient need to be diligent to diagnose and treat this entity promptly.