1/49. maintenance of serum calcium by parathyroid hormone-related peptide during lactation in a hypoparathyroid patient.We describe the changes in calcium homeostasis seen in a hypoparathyroid woman during the third trimester and with lactation following her second pregnancy. During lactation her need for supplemental calcium and calcitriol abated, and in fact she was transiently hypercalcemic and hypophosphatemic. This change was associated with a rise of serum parathyroid hormone-related peptide (PTHrP) released systemically during lactation. This is the first documentation of the time course of serum PTHrP levels from the late third trimester throughout lactation in a hypoparathyroid woman. In this context PTHrP may have sufficient biological activity to compensate for parathyroid hormone deficiency.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/49. Primary hyperparathyroidism in a twin pregnancy and review of fetal/maternal calcium homeostasis.BACKGROUND: hyperparathyroidism occurs rarely in pregnancy; this is the first reported case in a twin gestation. Management of this unusual case is described and an overview of fetal/maternal calcium homeostasis is discussed. methods: The patient presented at 33 weeks' gestation with hypertension and premature labor. serum calcium and phosphorus were 14.6 and 1.7 mg/dL, respectively. An intact parathyroid hormone (PTH) level was 243 pg/mL (normal, 10-65). RESULTS: The patient was treated with parenteral saline hydration and oral phosphate supplementation that was continued through week 37. Although the calcium remained elevated between 12.6 and 13.3 mg/dL, medical therapy was continued because of the risks of surgery in the third trimester. Alternative medical treatments (bisphosphonates, calcitonin) were considered ill advised in pregnancy. The patient remained asymptomatic without further labor, and at week 37, fraternal twins were delivered by cesarean section. The infants were monitored closely and experienced no hypocalcemic symptoms after delivery. Postpartum, the mother's parathyroid scan and ultrasound were negative. She underwent neck exploration and a single 700-mg adenoma was removed. Transient asymptomatic hypocalcemia (7.5 mg/dL) occurred postoperatively, and she was placed on oral calcium (1500 mg/day) and calcitriol (0.25 mg/day). These were stopped at 8 weeks, when both PTH and parathyroid hormone-related peptide levels were normal. CONCLUSION: Mother and infants continue to do well after 18 months. This case provides an interesting setting to consider the interrelationships between elevated maternal PTH and the fetal/placental factors that regulate calcium metabolism in pregnancy.- - - - - - - - - - ranking = 7.1575927520546keywords = pregnancy, gestation (Clic here for more details about this article) |
3/49. pregnancy complicated by concurrent primary hyperparathyroidism and arrhythmia.Primary hyperparathyroidism during pregnancy results in a high rate of fetal complications and maternal morbidity. Maternal hypercalcemia in pregnancy results in fetal hypercalcemia, which leads to suppression of fetal parathyroid function. Spontaneous abortion and stillbirth can occur, and the loss of maternal calcium after birth leads to neonatal hypocalcemia. It is essential to detect primary hyperparathyroidism during pregnancy because early diagnosis and management can decrease the rate of fetal and maternal complications. We present the case of a 27-year-old gravida 1, para 0 woman whose pregnancy was complicated by hyperparathyroidism and arrhythmia. The patient complained of dyspnea and palpitations in the seventh and 15th weeks of gestation. electrocardiography showed ventricular premature contraction bigeminy and trigeminy in association with hypercalcemia (3.3 mmol/L). A parathyroidectomy in the second trimester revealed parathyroid adenoma. hypercalcemia and arrhythmia resolved completely and the patient delivered a term baby without any maternal or fetal complications. The simultaneous occurrence of arrhythmia with ventricular premature contractions and hyperparathyroidism in pregnancy is rarely reported. Palpitations and dyspnea due to arrhythmia may be associated with primary hyperparathyroidism in pregnancy and should be considered in the differential diagnosis. In the management of symptomatic primary hyperparathyroidism during pregnancy, surgical intervention is preferable in the second trimester when organogenesis is completed and the risk of spontaneous abortion is low.- - - - - - - - - - ranking = 7.0787963760273keywords = pregnancy, gestation (Clic here for more details about this article) |
4/49. Course and outcome of pregnancy in a patient with mild, asymptomatic, primary hyperparathyroidism diagnosed before conception.Primary hyperparathyroidism (PHP) during pregnancy is well known to confer an increased risk of complications to both the mother and the fetus. However, the risks and optimal management of patients with mild, asymptomatic disease during pregnancy are much less clear. We observed a patient with mild, asymptomatic PHP who was diagnosed before conception through pregnancy. The patient remained asymptomatic through the first 22 weeks of pregnancy, and her calcium levels remained under 11 mg/dL. This occurred despite a dramatic elevation in the level of 1,25-dihydroxyvitamin D and marked hypercalciuria. Parathyroid surgery was performed at 22 weeks of gestation and a parathyroid adenoma was removed. Postoperatively, the patient's calcium level normalized and the rest of the pregnancy was uncomplicated. The patient delivered a healthy baby at 40 weeks of gestation. The neonatal course was unremarkable. We conclude that mild, asymptomatic PHP during early pregnancy is compatible with normal fetal development and an uncomplicated pregnancy and that the serum calcium level in such patients can remain stable with medical management alone, despite the marked changes in maternal calcium metabolism that characterize normal pregnancy.- - - - - - - - - - ranking = 12.157592752055keywords = pregnancy, gestation (Clic here for more details about this article) |
5/49. A case report of primary hyperparathyroidism with severe bony involvement and nephrolithiasis.INTRODUCTION: Although the majority of patients with primary hyperparathyroidism have a relatively asymptomatic benign disorder, there are patients who have a more aggressive disorder. CLINICAL PICTURE: We report a case of primary hyperparathyroidism presenting during pregnancy complicated by antepartum haemorrhage and severe prematurity. The diagnosis was made postpartum, when her problems rapidly progressed to result in severe neuromuscular weakness, bilateral pathological hip fractures as well as nephrolithiasis. TREATMENT: Surgical parathyroidectomy was performed. The underlying lesion was a large solitary parathyroid adenoma with cystic elements. CONCLUSION: Primary hyperparathyroidism is not an innocuous disease and can result in severe morbidity if left untreated.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
6/49. nephrolithiasis during pregnancy secondary to primary hyperparathyroidism.nephrolithiasis secondary to primary hyperparathyroidism infrequently complicates pregnancy. It can cause severe maternal and fetal complications. We present a case of a pregnant woman with nephrolithiasis and primary hyperparathyroidism. We reviewed the management of nephrolithiasis due to primary hyperparathyroidism during pregnancy. We believe that early recognition and timely intervention can significantly reduce the incidence of complications.- - - - - - - - - - ranking = 6keywords = pregnancy (Clic here for more details about this article) |
7/49. Primary hyperparathyroidism and acute pancreatitis during the third trimester of pregnancy.The simultaneous occurrence of maternal primary hyperparathyroidism (PHPT) and acute pancreatitis during pregnancy is very rare. We report a case of concurrent PHPT and pancreatitis during the third trimester of pregnancy. A summary of the relevant literature regarding the clinical course and recommended management in relation to this case is also presented.- - - - - - - - - - ranking = 6keywords = pregnancy (Clic here for more details about this article) |
8/49. hyperparathyroidism and pregnancy. Report of a case and review of the literature.A 28-year-old gravida III, with a history of two unsuccessful pregnancies, was admitted with hyperemesis gravidarum and was found to be suffering from hyperparathyroidism (HPT). She was treated surgically and was later delivered of a wellformed, premature girl. The literature is reviewed and the histories of 40 females (including the patient of this case report) with a minimum of 93 pregnancies while suffering from HPT shows, that HPT during pregnancy is a serious condition for the fetus as well as for the mother. There was an increased incidence of spontaneous abortion, perinatal death, premature birth and neonatal morbidity. The mothers suffered from increased episodes of renal calculi and hyperemesis gravidarum. The exacerbations nearly always occurred in the first and second trimesters or post partum.- - - - - - - - - - ranking = 5keywords = pregnancy (Clic here for more details about this article) |
9/49. pancreatitis secondary to hyperparathyroidism during pregnancy.BACKGROUND: It has been suggested that magnesium can be used to reduce serum calcium levels seen with hyperparathyroidism during pregnancy, thus reducing maternal and fetal risk. CASE: A young woman presented at 32 weeks' gestation with abdominal pain from pancreatitis caused by hyperparathyroidism from a parathyroid adenoma. She was started on magnesium sulfate tocolysis for preterm labor. During treatment, serum parathyroid hormone was undetectable, but serum calcium and vitamin d-1,25 were elevated. When magnesium was discontinued, her vitamin d-1,25 was suppressed and the parathyroid hormone was elevated. CONCLUSION: For some patients, because of persistent hypercalcemia, magnesium sulfate might not be a viable treatment option for hyperparathyroidism during pregnancy.- - - - - - - - - - ranking = 6.0787963760273keywords = pregnancy, gestation (Clic here for more details about this article) |
10/49. Surgical treatment of primary hyperparathyroidism during the third trimester.BACKGROUND: Primary hyperparathyroidism is a rare diagnosis in the third trimester of pregnancy. A 58% fetal complication rate, including perinatal death and preterm labor, following late gestation parathyroidectomy has been reported. These statistics, however, are based on small sample sizes and were reported when our current technology was unavailable. CASE: A 30-year-old woman presented in the early third trimester with primary hyperparathyroidism. Despite conservative management, her ionized calcium level increased to 1.88 mmol/L (normal 1.17-1.33 mmol/L). At 3447 weeks, she had an uncomplicated parathyroidectomy. At 3837 weeks she delivered a 3182-g female infant. Neither the mother nor baby had complications. CONCLUSION: This supports the contention that pregnant women with hyperparathyroidism not controlled by conservative measures can be treated successfully with parathyroidectomy, regardless of gestational age.- - - - - - - - - - ranking = 1.1575927520546keywords = pregnancy, gestation (Clic here for more details about this article) |
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