Primary hyperparathyroidism in pregnancy: observations from the Indian PHPT registry
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ORIGINAL ARTICLE
Primary hyperparathyroidism in pregnancy: observations from the Indian PHPT registry R. Pal1 · S. K. Bhadada1 · N. Gupta1 · A. Behera2 · N. Aggarwal3 · A. Aggarwal1 · K. V. Raviteja1 · U. N. Saikia4 · G. Kaur1 · S. M. Arvindbhai1 · R. Walia1 Received: 14 July 2020 / Accepted: 29 September 2020 © Italian Society of Endocrinology (SIE) 2020
Abstract Purpose To present the data on primary hyperparathyroidism (PHPT) in pregnancy from India obtained from a large database maintained over 15 years. Methods We retrieved data of all women with gestational PHPT from the Indian PHPT registry between July 2005 and January 2020, and compared their clinical, biochemical, and other characteristics with age-matched non-pregnant women with PHPT. Results Out of 386 women, eight had gestational PHPT (2.1%). The common presenting manifestations were acute pancreatitis (50%) and renal stone disease (50%); two were asymptomatic. Five women (62.5%) had a history of prior miscarriages. Seven patients (88%) had preeclampsia during the present gestation. Serum calcium and intact parathyroid hormone (iPTH) were not statistically different from the age-matched non-pregnant PHPT group. Six patients with mild-to-moderate hypercalcemia were medically managed with hydration with/without cinacalcet while one patient underwent percutaneous ethanol ablation of the parathyroid adenoma; none underwent surgery during pregnancy. Mean serum calcium maintained from treatment initiation till delivery was 10.5 ± 0.4 mg/dl. One patient had spontaneous preterm delivery at 36 weeks; the remaining patients had normal vaginal delivery at term. None had severe preeclampsia/eclampsia. Fetal outcomes included low birth weight in three newborns (37.5%); two of them had hypocalcemic seizures. Conclusion The prevalence of gestational PHPT was 2.1% in this largest Indian PHPT cohort, which is higher than that reported from the West ( 10.2 mg/ dl on at least two occasions performed on 2 consecutive days) along with inappropriately elevated plasma intact parathyroid hormone (iPTH) [10]. Localization of the parathyroid lesion was performed by ultrasonography (USG) of neck supplemented by 99mTc-SestaMIBI scintigraphy; it was deferred in pregnant patients till delivery. All patients providing consent underwent parathyroidectomy. The decision to perform a focused parathyroidectomy vs. 4-gland
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Journal of Endocrinological Investigation
exploration was made based on the patient’s age, preoperative imaging findings, genetic analysis (wherever available), and intraoperative findings. The excised tissue was subjected to histopathological examination. All patients were monitored for signs and symptoms of hypocalcemia for the first 7 days post-operatively. Cure of PHPT was defined as > 50% decrease in iPTH from baseline with normalization of serum calcium levels measured between post-operative days 3 and 7. Serum calcium/iPTH were also measured at 3 months post surgery and thereafter every 6 months unless otherwise indicated [10].
Biochemical and horm
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