Hyperparathyroidism and pregnancy

BACKGROUND: Hyperparathyroidism during pregnancy can carry significant morb idity to both mother and fetus. Surgery is the definitive treatment of choi ce although medical management is occasionally warranted. This report looks at 6 cases of hyperparathyroidism during pregnancy and reviews the morbidi ty 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 perform ed. In 6 cases, hyperparathyroidism occurred during pregnancy. Serum calciu m was measured in all patients before and after parathyroidectomy. RESULTS: A total of 6 of 750 patients (0.8%) were found to have hyperparath yroidism 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 pat ients presented with hyperemesis gravidarum, 2 were asymptomatic, and 1 had recurrent urinary tract infection. CONCLUSION: Hyperparathyroidism during pregnancy, while rare, remains a pre ventable cause of fetal morbidity and mortality, Based on our case series a nd review of the literature, surgery is the definitive treatment of choice and is considered safe and effective if performed during the second trimest er of pregnancy. Those involved with the care of the pregnant patient need to be diligent to diagnose and treat this entity promptly. Am J Surg. 1999; 177:66-68, (C) 1999 by Excerpta Medica, Inc.