Oral Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

Primary hyperparathyroidism in pregnancy: a retrospective review of management and maternofetal outcomes at the Royal Brisbane and Women’s Hospital 2000 to 2015. (#63)

Jane Rigg 1 2 , Elise Gilbertson 3 4 , Helen Barrett 1 5 6 , Fiona Britten 1 5 , Karin Lust 1 5
  1. Royal Brisbane Clinical Unit, The University of Queensland, Herston, Qld , Australia
  2. Internal Medicine, Caboolture Hospital, Caboolture, QLD, Australia
  3. Internal Medicine, Sunshine Coast University Hospital, Birtinya, Qld, Australia
  4. Sunshine Coast Clinical Unit, The University of Queensland, Birtinya, Qld, Australia
  5. Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
  6. UQ Centre for Clinical Research RBWH Campus, Herston, Qld, Australia

Objectives: Primary hyperparathyroidism (PHPT) in pregnancy has historically been associated with significant maternofetal morbidity and mortality. This study reviewed maternofetal outcomes of medically and surgically managed patients at the Royal Brisbane and Women’s Hospital between 1/1/00 and 31/12/15 inclusive.

Methods: Charts for 23 patients, amongst whom there were 28 pregnancies (2 that ended in early miscarriage), were reviewed. Details of conservative and/or surgical treatment were recorded. Pregnancy outcomes assessed included gestation at delivery, indication for and mode of delivery, and the development of complications attributable to PHPT (miscarriage, pregnancy-induced hypertension or pre-eclampsia, urinary tract infections, nephrolithiasis, pancreatitis and hypercalcaemic crisis). Neonatal outcomes assessed included birth weight, Apgar scores at 5 minutes, admission to the neonatal intensive care unit (NICU) and neonatal hypocalcaemia (with or without tetany or seizures).

Results: Twenty-two pregnancies were managed conservatively, whilst 6 patients underwent parathyroidectomy in pregnancy (5 in trimester 2, and 1 at K324). Most patients managed conservatively either had a corrected serum calcium concentration less than 2.85 mmol/L in early pregnancy or were diagnosed in trimester 3. Of viable conservatively managed pregnancies, 30% were complicated by pre-eclampsia, and pre-term delivery occurred in 50% of this group. All pre-term neonates required admission to NICU for complications related to prematurity. All surgically managed patients were delivered at term, and there were no complications of parathyroid surgery. There was 1 case of transient neonatal hypocalcaemia that did not require treatment, and no cases of neonatal tetany or seizures.

Conclusions: Maternofetal complications attributable to primary hyperathyroidism in pregnancy appear to have improved relative to that in early medical literature in both conservatively and surgically managed patients. However, conservative management was associated with an increased risk of pre-eclampsia. Surgery in trimester 2 appears to be safe. More information on surgery in trimester 3 is required.