背景:妊娠期原发性甲状旁腺功能亢进(PHPT)诱导的急性胰腺炎(AP)很少被描述。由于这种稀有性,妊娠患者没有诊断或治疗算法。
目的:为了确定适当的诊断方法,治疗选择,以及PHPT诱导的妊娠AP的母婴结局相关因素。
方法:对英文文章的文献检索,日本人,德语,西班牙语,意大利语是使用PubMed(1946-2023)进行的,PubMedCentral(1900-2023),谷歌学者。遵循系统评价和荟萃分析(PRISMA)方案的首选报告项目。搜索词包括“胰腺磷灰石,\“\”辅助原色,\"\"gravidanza,\"\"Travaglio,\"\"purerperio,“产后,\"\"akute胰腺炎,\“\”primärerhyperparathyreoidmuss,\"\"Schwangerschaft,\"\"Wehen,\"\"Wochenbett,\"\"胰腺炎阿古达,\"\"hiperparatiroidisphismoprimario,\"\"embarazo,\"\"parto,\"\"purerperio,\"\"posparto,急性胰腺炎,\"\"原发性甲状旁腺功能亢进,\"\"怀孕,\“\”劳动,\"\"产褥期,“和”产后。“通过回顾检索到的研究的参考列表,确定了其他研究。人口统计,成像,外科,产科,并获得结果数据。
结果:从51项研究中收集了54例病例。产妇年龄中位数为29岁。PHPT诱导的AP在第20孕周开始;死亡的母亲的孕周较高(平均孕周28)。淀粉酶中值(1399,Q1-Q3=519-2072),脂肪酶(2072,Q1-Q3=893-2804),血清钙(3.5,Q1-Q3=3.1-3.9),和甲状旁腺激素(PTH)(384,Q1-Q3=123-910)报告。在46个案例中,腺瘤是PHPT的病因,其次是癌2例,增生1例。其余5例,没有报告诊断。颈部超声阳性34例,而Sestamibi在3例中进行了治疗,9例进行了颈部计算机断层扫描或磁共振成像(3例甲状旁腺扩大未定位)。手术是妊娠期间的首选治疗方法33例(妊娠中位周25,Q1-Q3=20-30),产后12例。其余9例没有报告时间,或未进行手术。手术治疗AP11例,保守治疗43例(79.6%)。孕产妇和胎儿死亡率为9.3%(5例)。手术在已故母亲中更为常见(60.0%vs16.3%;P=0.052),和PTH值在该组中倾向于更高(910pg/mL对302pg/mL;P=0.059)。血清脂肪酶水平较高和分娩周较早,孕产妇死亡率较高。较高的钙(4.1mmol/L比3.3mmol/L;P=0.009)和PTH(1914pg/mL比302pg/mL;P=0.003)值增加了胎儿/儿童死亡率,以及流产(40.0%vs0.0%;P=0.007)和复杂分娩(60.0%vs8.2%;P=0.01)。
结论:如果入院期间未检测血清钙,妊娠PHPT诱导的AP的明确诊断延迟,而早期诊断和立即干预可导致良好的母婴结局。
BACKGROUND: Primary hyperparathyroidism (PHPT)-induced acute pancreatitis (AP) during pregnancy has rarely been described. Due to this rarity, there are no diagnostic or treatment algorithms for pregnant patients.
OBJECTIVE: To determine appropriate diagnostic methods, therapeutic options, and factors related to maternal and fetal outcomes for PHPT-induced AP in pregnancy.
METHODS: A literature search of articles in English, Japanese, German, Spanish, and Italian was performed using PubMed (1946-2023), PubMed Central (1900-2023), and Google Scholar. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol was followed. The search terms included \"pancreatite acuta,\" \"iperparatiroidismo primario,\" \"gravidanza,\" \"travaglio,\" \"puerperio,\" \"postpartum,\" \"akute pankreatitis,\" \"primärer hyperparathyreoidismus,\" \"Schwangerschaft,\" \"Wehen,\" \"Wochenbett,\" \"pancreatitis aguda,\" \"hiperparatiroidismo primario,\" \"embarazo,\" \"parto,\" \"puerperio,\" \"posparto,\" \"acute pancreatitis,\" \"primary hyperparathyroidism,\" \"pregnancy,\" \"labor,\" \"puerperium,\" and \"postpartum.\" Additional studies were identified by reviewing the reference lists of retrieved studies. Demographic, imaging, surgical, obstetric, and outcome data were obtained.
RESULTS: Fifty-four cases were collected from the 51 studies. The median maternal age was 29 years. PHPT-induced AP starts at the 20th gestational week; higher gestational weeks were seen in mothers who died (mean gestational week 28). Median values of amylase (1399, Q1-Q3 = 519-2072), lipase (2072, Q1-Q3 = 893-2804), serum calcium (3.5, Q1-Q3 = 3.1-3.9), and parathormone (PTH) (384, Q1-Q3 = 123-910) were reported. In 46 cases, adenoma was the cause of PHPT, followed by 2 cases of carcinoma and 1 case of hyperplasia. In the remaining 5 cases, the diagnosis was not reported. Neck ultrasound was positive in 34 cases, whereas sestamibi was performed in 3 cases, and neck computed tomography or magnetic resonance imaging was performed in 9 cases (the enlarged parathyroid gland was not localized in 3 cases). Surgery was the preferred treatment during pregnancy in 33 cases (median week of gestation 25, Q1-Q3 = 20-30) and postpartum in 12 cases. The timing was not reported in the remaining 9 cases, or surgery was not performed. AP was managed surgically in 11 cases and conservatively in 43 (79.6%) cases. Maternal and fetal mortality was 9.3% (5 cases). Surgery was more common in deceased mothers (60.0% vs 16.3%; P = 0.052), and PTH values tended to be higher in this group (910 pg/mL vs 302 pg/mL; P = 0.059). Maternal mortality was higher with higher serum lipase levels and earlier delivery week. Higher calcium (4.1 mmol/L vs 3.3 mmol/L; P = 0.009) and PTH (1914 pg/mL vs 302 pg/mL; P = 0.003) values increased fetal/child mortality, as well as abortions (40.0% vs 0.0%; P = 0.007) and complex deliveries (60.0% vs 8.2%; P = 0.01).
CONCLUSIONS: If serum calcium is not tested during admission, definitive diagnosis of PHPT-induced AP in pregnancy is delayed, while early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes.