METHODS: A review of the literature was performed by consulting the Pubmed, Cochrane Library, and Science Direct databases.
RESULTS: Primary hyperparathyroidism is defined as excessive production of parathyroid hormone resulting in hypercalcemia. The prevalence of primary hyperparathyroidism during pregnancy is not known. Indeed, the symptomatology, related to hypercalcemia, is not very specific and easily confused with the clinical manifestations of pregnancy. The physiological changes specific to the pregnant state frequently lead to a slight hypocalcemia which may complicate the diagnosis of primary hyperparathyroidism. Primary hyperparathyroidism results from a parathyroid adenoma in the majority of cases and is detected by ultrasound during pregnancy. Primary hyperparathyroidism in pregnancy causes significant risks to both mother and fetus. The maternal complication rate is 14-67%, however, the most serious complication is hypercalcemic crisis, which requires increased surveillance in the postpartum period. Obstetrical complications are also induced by primary hyperparathyroidism, such as acute polyhydramnios, or intrauterine growth retardation. The fetal complication rate can reach 45-80% of cases with neonatal hypocalcemia as the main complication. If medical treatment is based on hyperhydration, only surgical treatment is curative.
CONCLUSIONS: Surgery should be proposed to symptomatic patients or those with high blood calcium levels, discussed in interdisciplinary committee and should be organized ideally in the second trimester to avoid maternal and fetal complications.
方法:通过咨询Pubmed,科克伦图书馆,和科学直接数据库。
结果:原发性甲状旁腺功能亢进定义为甲状旁腺激素的过量产生导致高钙血症。妊娠期原发性甲状旁腺功能亢进的患病率尚不清楚。的确,症状学,与高钙血症有关,不是很具体,容易与妊娠的临床表现混淆。特定于妊娠状态的生理变化经常导致轻微的低钙血症,这可能使原发性甲状旁腺功能亢进的诊断复杂化。在大多数情况下,原发性甲状旁腺功能亢进是由甲状旁腺腺瘤引起的,并且在怀孕期间通过超声检测到。妊娠期原发性甲状旁腺功能亢进会对母亲和胎儿造成重大风险。产妇并发症发生率为14-67%,然而,最严重的并发症是高血钙危象,这需要在产后加强监测。原发性甲状旁腺功能亢进也会引起产科并发症,如急性羊水过多,或宫内发育迟缓。以新生儿低钙血症为主要并发症的病例,胎儿并发症发生率可达45~80%。如果药物治疗是基于过度水合,只有手术治疗才有疗效。
结论:对于有症状的患者或有高血钙水平的患者,应建议进行手术。在跨学科委员会进行讨论,并应在妊娠中期进行理想的组织,以避免孕产妇和胎儿并发症。