scholarly journals Primary Hyperparathyroidism in Pregnancy: Successful Parathyroidectomy during First Trimester

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Niranjan Tachamo ◽  
Bidhya Timilsina ◽  
Rashmi Dhital ◽  
Theresa Lynn ◽  
Vasudev Magaji ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Conservative Management ◽  
First Trimester ◽  
Second Trimester ◽  
Therapeutic Challenge ◽  
Fetal Complications ◽  
In Pregnancy

Primary hyperparathyroidism in pregnancy can result in significant maternal and fetal complications. When indicated, prompt parathyroidectomy in the early second trimester is considered the treatment of choice. Pregnant patients with primary hyperparathyroidism who have an indication for parathyroidectomy during the first trimester represent a therapeutic challenge. We present the case of a 32-year-old primigravida who presented with symptomatic hypercalcemia from her primary hyperparathyroidism. She remained symptomatic despite aggressive conservative management and underwent parathyroidectomy in her first trimester with excellent outcomes.

scholarly journals Primary Hyperparathyroidism in Pregnancy: A Two-Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
A. D. Herrera-Martínez ◽  
R. Bahamondes-Opazo ◽  
R. Palomares-Ortega ◽  
C. Muñoz-Jiménez ◽  
M. A. Gálvez-Moreno ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Early Diagnosis ◽  
Literature Review ◽  
Primary Hyperparathyroidism ◽  
Serum Levels ◽  
Second Trimester ◽  
Uncommon Disease ◽  
Fetal Complications ◽  
In Pregnancy

Primary hyperparathyroidism (PHPT) in pregnant women is an uncommon disease. It could be easily misdiagnosed because of physiologic changes during pregnancy; in some cases, patients could remain asymptomatic maintaining elevated calcium serum levels, and this situation represents a threat to the health of both mother and fetus. We present two cases of PHPT during pregnancy and their evolution after surgical treatment in the second trimester; there were no observed complications during pregnancy or delivery in our patients. Early diagnosis and medical/surgical treatment in PHPT are necessary for avoiding maternal and fetal complications which could not be predicted based on duration or severity of hypercalcemia. An appropriate management of PHPT during pregnancy is necessary for preserving the health of both the woman and the fetus.

scholarly journals Surgical Treatment of “Large Uterine Masses” in Pregnancy: A Single-Center Experience

2021 ◽  
Vol 18 (22) ◽  
pp. 12139
Author(s):  
Anna Franca Cavaliere ◽  
Annalisa Vidiri ◽  
Salvatore Gueli Alletti ◽  
Anna Fagotti ◽  
Maria Concetta La Milia ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Uterine Fibroids ◽  
First Trimester ◽  
Second Trimester ◽  
Histologic Diagnosis ◽  
Single Center Experience ◽  
Fetal Complications ◽  
Benign Nature ◽  
The Masses ◽  
In Pregnancy

Uterine myomas or uterine fibroids are the most common benign uterine masses affecting women. The management of large myoma during pregnancy is challenging, and surgical treatment is a possible option. We report nine cases of pregnant women affected by uterine masses larger than 10 cm, who underwent surgical treatment during the second trimester of pregnancy. In all cases, the masses were preconceptionally unknown and diagnosed during the first trimester. In eight cases, no maternal and fetal complications arose during or after surgical treatment and delivery occurred at full term of pregnancy. In one case, spontaneous abortion was recorded. In all cases, histologic diagnosis demonstrated the benign nature. Women affected by large uterine masses diagnosed for the first time in pregnancy could be taken into consideration for surgical treatment in a referral center during the second trimester.

scholarly journals Management of primary hyperparathyroidism in pregnancy: a case series

2019 ◽  
Vol 2019 ◽  
Author(s):  
Aisling McCarthy ◽  
Sophie Howarth ◽  
Serena Khoo ◽  
Julia Hale ◽  
Sue Oddy ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Case Series ◽  
Definitive Treatment ◽  
List Type ◽  
Second Trimester ◽  
Management Options ◽  
Neonatal Complications ◽  
Fetal Complications ◽  
In Pregnancy

Summary Primary hyperparathyroidism (PHPT) is characterised by the overproduction of parathyroid hormone (PTH) due to parathyroid hyperplasia, adenoma or carcinoma and results in hypercalcaemia and a raised or inappropriately normal PTH. Symptoms of hypercalcaemia occur in 20% of patients and include fatigue, nausea, constipation, depression, renal impairment and cardiac arrythmias. In the most severe cases, uraemia, coma or cardiac arrest can result. Primary hyperparathyroidism in pregnancy is rare, with a reported incidence of 1%. Maternal and fetal/neonatal complications are estimated to occur in 67 and 80% of untreated cases respectively. Maternal complications include nephrolithiasis, pancreatitis, hyperemesis gravidarum, pre-eclampsia and hypercalcemic crises. Fetal complications include intrauterine growth restriction; preterm delivery and a three to five-fold increased risk of miscarriage. There is a direct relationship between the degree of severity of hypercalcaemia and miscarriage risk, with miscarriage being more common in those patients with a serum calcium greater than 2.85 mmol/L. Neonatal complications include hypocalcemia. Herein, we present a case series of three women who were diagnosed with primary hyperparathyroidism in pregnancy. Case 1 was diagnosed with multiple endocrine neoplasia type 1 (MEN1) in pregnancy and required a bilateral neck exploration and subtotal parathyroidectomy in the second trimester of her pregnancy due to symptomatic severe hypercalcaemia. Both case 2 and case 3 were diagnosed with primary hyperparathyroidism due to a parathyroid adenoma and required a unilateral parathyroidectomy in the second trimester. This case series highlights the work-up and the tailored management approach to patients with primary hyperparathyroidism in pregnancy. Learning points: Primary hyperparathyroidism in pregnancy is associated with a high incidence of associated maternal fetal and neonatal complications directly proportionate to degree of maternal serum calcium levels. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism in pregnancy and was used in the management of all three cases in this series. It is recommended when serum calcium is persistently greater than 2.75 mmol/L and or for the management of maternal or fetal complications of hypercalcaemia. Surgical management, when necessary is ideally performed in the second trimester. Primary hyperparathyroidism is genetically determined in ~10% of cases, where the likelihood is increased in those under 40 years, where there is relevant family history and those with other related endocrinopathies. Genetic testing is a useful diagnostic adjunct and can guide treatment and management options for patients diagnosed with primary hyperparathyroidism in pregnancy, as described in case 1 in this series, who was diagnosed with MEN1 syndrome. Women of reproductive age with primary hyperparathyroidism need to be informed of the risks and complications associated with primary hyperparathyroidism in pregnancy and pregnancy should be deferred and or avoided until curative surgery has been performed and calcium levels have normalised.

Primary Hyperparathyroidism in Pregnancy: A Diagnostic and Therapeutic Challenge

2010 ◽  
Vol 19 (6) ◽  
pp. 1117-1121 ◽  
Author(s):  
I.-L. Nilsson ◽  
N. Adner ◽  
E. Reihnér ◽  
C. Palme-Kilander ◽  
G. Edstrom ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Therapeutic Challenge ◽  
In Pregnancy

scholarly journals A rare case of hypercalcemia-induced pancreatitis in a first trimester pregnant woman

2018 ◽  
Vol 2018 ◽  
Author(s):  
Carine Ghassan Richa ◽  
Khadija Jamal Saad ◽  
Ali Khaled Chaaban ◽  
Mohamad Souheil El Rawas
Keyword(s):  
Acute Pancreatitis ◽  
Pregnant Woman ◽  
Primary Hyperparathyroidism ◽  
Rare Case ◽  
First Trimester ◽  
List Type ◽  
Second Trimester ◽  
Adequate Treatment ◽  
Severe Hypercalcemia ◽  
First Trimester Of Pregnancy

Summary The objective of the study is to report a case of acute pancreatitis secondary to hypercalcemia induced by primary hyperparathyroidism in a pregnant woman at the end of the first trimester. The case included a 32-year-old woman who was diagnosed with acute pancreatitis and severe hypercalcemia refractory to many regimens of medical therapy in the first trimester of pregnancy. She was successfully treated with parathyroidectomy in the early second trimester with complete resolution of hypercalcemia and pancreatitis. Neonatal course was unremarkable. To our best knowledge, this is a rare case when primary hyperparathyroidism and its complications are diagnosed in the first trimester of pregnancy. In conclusion, primary hyperparathyroidism is a rare life-threatening condition to the fetus and mother especially when associated with complications such as pancreatitis. Early therapeutic intervention is important to reduce the morbidity and mortality. Parathyroidectomy performed in the second trimester can be the only solution. Learning points: Learning how to make diagnosis of primary hyperparathyroidism in a woman during the first trimester of pregnancy. Understanding the complications of hypercalcemia and be aware of the high mortality and sequelae in both fetus and mother. Providing the adequate treatment in such complicated cases with coordinated care between endocrinologists and obstetricians to ensure optimal outcomes.

A Comparative Study on Serum Levels of Iron, Magnesium, Calcium and Phosphorus during First & Second Trimesters of Pregnancy at a Tertiary Referral Hospital in South India

2021 ◽  
Vol 8 (29) ◽  
pp. 2609-2614
Author(s):  
Pradeep Kumar M ◽  
Mayadevi Brahmanandan ◽  
Dini S.B
Keyword(s):  
Body Mass Index ◽  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Serum Levels ◽  
First Trimester ◽  
Second Trimester ◽  
Mean Values ◽  
Calcium And Phosphorus ◽  
In Pregnancy

BACKGROUND Multiple micronutrient deficiencies commonly coexist in pregnancy and may play a role in the pathogenesis of many high-risk events in pregnancy. Mineral estimation during the first and second trimester may help in the identification of high-risk pregnancies predisposed to pre-eclampsia, preterm birth or low birth weight. Body mass index (BMI) is an independent risk factor influencing the serum levels of micronutrients like iron, calcium, phosphorous and magnesium. The purpose of this study was to compare the serum levels of iron, magnesium, calcium and phosphorus during first & second trimesters of pregnancy and their correlation with body mass index and adverse pregnancy outcomes. METHODS This was a longitudinal descriptive study, done over a period of twelve months, from April 2017 to March 2018. 94 low risk pregnant women were selected in the first trimester, and they were followed up for the entire duration of pregnancy. 2 ml of blood is collected at first and second trimester and analysed for the serum levels of iron (µg/dl), magnesium (mg/dl), calcium (mg/dl) and inorganic phosphorus (mg/dl). Mean values of these elements were noted and BMI was measured. Patients were followed up to observe the pregnancy outcome, especially development of hypertension, preterm birth and low birth weight. The data were subjected to suitable statistical analyses. P value less than 0.05 is considered as statistically significant. RESULTS Mean values of Ca, Mg, inorganic P and Fe were 9.3 mg/dl ± 0.52, 1.79 mg/dl ± 0.28, 3.59 mg/dl ± 0.54 and 83.7 µg/dl ± 25.36 respectively in first trimester and 8.9 mg/dl ± 0.47, 1.62 mg/dl ± 0.16, 3.17 mg/dl ± 0.44 and 76.17 µg/dl ± 21. 69 respectively in the second trimester. Hypocalcaemia was noted in 12.7 % and 38.3 % in the first and second trimester respectively. Hypomagnesaemia was seen in 51.1 % and 80.9 % in the first and second trimester respectively. Hypophosphatemia was seen in 3.2 % and 14.8 % in the first and second trimester respectively. These findings were statistically significant. There was no significant change in the iron levels in the present study. 19.1 % were underweight. 56.4 % had normal BMI. 19.2 % were overweight. 5.3 % were obese. CONCLUSIONS There is no correlation between serum values of trace elements and the BMI of study subjects. Even though significant hypocalcaemia, hypophosphatemia and hypomagnesaemia was noted in second trimester compared to first, there was no predisposition to the development of adverse outcomes like pre-eclampsia, preterm birth or low birth weight. This may be the effect of dietary and pharmacological supplementation during pregnancy. KEYWORDS Micronutrients, Pregnancy Complications, Calcium, Phosphorus, Magnesium, Iron

Regulation of Microparticles and Adhesion Molecules in Pregnancy. Diagnostic and Pathophysiologic Implications.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1639-1639
Author(s):  
Debra Hoppensteadt ◽  
Josephine Cunanan ◽  
Anita Sylvester Anderson ◽  
Thomas Bergholt ◽  
Jorgen Berthelsen ◽  
...  
Keyword(s):  
Adhesion Molecules ◽  
Inflammatory Responses ◽  
Sandwich Elisa ◽  
Coagulation Factors ◽  
First Trimester ◽  
Second Trimester ◽  
Third Trimester ◽  
Cellular Activation ◽  
Rebound Increase ◽  
In Pregnancy

Abstract OBJECTIVE In addition to increased levels of coagulation factors and platelet counts,, microparticles are also found in increased numbers in pregnancy and are generated due to cellular activation and consumption. Microparticles may also be capable of amplifying the procoagulant and inflammatory responses by up regulating the adhesion molecules such as P, E and L selectins. This study will provide newer data on the regulation of microparticles in different trimesters of pregnancy and their relevance to the generation of adhesion molecules and tissue factor (TF). STUDY DESIGN Blood samples from pregnant women at their first prenatal visit and during the second and third trimester (n=50) were collected and citrated plasma samples were profiled for TF (American Diagnostica, Stamford, CT), E, L and P-selection (R &D Systems, Minneapolis, MN) by using commercially available sandwich ELISA methods and microparticles utilizing a functional method from Hyphen Biomed (Neuville-Sur-Oise, France). The results were compiled for each trimester and compared to aged match non-pregnant controls (n=40). RESULTS During the first trimester all of the mediators were increased in comparison to the controls. The relative increase was mediator dependent. L-selectin remained elevated, at a steady level, throughout the pregnancy. E-selectin showed a decrease in the second trimester with a rebound increase in the third trimester. A gradual increase in the TF and microparticles was evident throughout the pregnancy. The P-selectin levels decreased during the second trimester and stayed at this level for the remainder of the pregnancy. CONCLUSION Throughout pregnancy the TF levels directly correlated with an increase in the MP levels indicating that TF cause cellular activation leading to the formation of MPs. However, the levels of the adhesion molecules, which were initially elevated, fluctuate throughout the 2nd and 3rd trimester. These results suggest that increased levels of TF and MPs are progressively generated during pregnancy and may be responsible for the observed thrombotic complications and prothrombotic state in pregnancy.

scholarly journals A Longitudinal Study of Thyroid Markers Across Pregnancy and the Risk of Gestational Diabetes

2018 ◽  
Vol 103 (7) ◽  
pp. 2447-2456 ◽  
Author(s):  
Shristi Rawal ◽  
Michael Y Tsai ◽  
Stefanie N Hinkle ◽  
Yeyi Zhu ◽  
Wei Bao ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
De Novo ◽  
Conditional Logistic Regression ◽  
Thyroid Autoimmunity ◽  
First Trimester ◽  
Biologically Active ◽  
Second Trimester ◽  
Free T4 ◽  
Control Study ◽  
In Pregnancy

Abstract Context T3 is the biologically active thyroid hormone involved in glucose metabolism. The free T3 (fT3)/free T4 (fT4) ratio, a marker indicating conversion of fT4 to fT3, is also implicated in glucose homeostasis. Objective To examine associations of fT3 and the fT3/fT4 ratio with gestational diabetes mellitus (GDM). Design In a case-control study, thyroid markers (fT3, fT4, TSH) were measured and the fT3/fT4 ratio was derived across four visits in pregnancy, including first (gestational weeks 10 to 14) and second (weeks 15 to 26) trimester. Conditional logistic regression adjusting for thyroid autoimmunity status and major GDM risk factors estimated trimester-specific associations of thyroid markers with subsequent GDM risk. Setting Twelve US clinical centers. Participants One hundred seven GDM cases and 214 non-GDM controls from a multiracial pregnancy cohort of 2802 women. Main Outcome Measures GDM diagnosis ascertained from medical records. Results Both fT3 and the fT3/fT4 ratio were positively associated with GDM: adjusted OR (95% CI) comparing the highest vs lowest fT3 quartile was 4.25 (1.67, 10.80) at the first trimester and 3.89 (1.50, 10.10) at the second trimester. Similarly, the corresponding risk estimates for the fT3/fT4 ratio were 8.63 (2.87, 26.00) and 13.60 (3.97, 46.30) at the first and second trimester, respectively. Neither TSH nor fT4 was significantly associated with GDM. Conclusions Higher fT3 levels, potentially resulting from de novo synthesis or increased fT4 to fT3 conversion, may be an indicator of GDM risk starting early in pregnancy.

scholarly journals The Biochemical Profile of Familial Hypocalciuric Hypercalcemia and Primary Hyperparathyroidism during Pregnancy and Lactation: Two Case Reports and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
S. A. Ghaznavi ◽  
N. M. A. Saad ◽  
L. E. Donovan
Keyword(s):  
Primary Hyperparathyroidism ◽  
Case Reports ◽  
Diagnostic Error ◽  
Calcium Handling ◽  
Familial Hypocalciuric Hypercalcemia ◽  
Second Trimester ◽  
Clearance Ratio ◽  
Fetal Complications ◽  
Pregnancy And Lactation ◽  
History Of

Background. Primary hyperparathyroidism (PHPT) and Familial Hypocalciuric Hypercalcemia (FHH) result in different maternal and fetal complications in pregnancy. Calcium to creatinine clearance ratio (CCCR) is commonly used to help distinguish these two conditions. Physiological changes in calcium handling during pregnancy and lactation can alter CCCR, making it a less useful tool to distinguish PHPT from FHH. Cases. A 25-year-old female presented with hypercalcemia and an inappropriately normal PTH. Her CCCR was 0.79% before pregnancy and rose to 1.99% in her second trimester. The proband’s mother and neonate had asymptomatic hypercalcemia. Genetic analysis revealed a CaSR mutation consistent with FHH. A 19-year-old female presented with a history of nephrolithiasis who underwent emergent caesarean section at 29 weeks of gestation for severe preeclampsia. At delivery, she was diagnosed with hypercalcemia with an inappropriately normal PTH and a CCCR of 2.67%, which fell to 0.88% during lactation. Parathyroidectomy cured her hypercalcemia. Pathology confirmed a parathyroid adenoma. Conclusion. These cases illustrate the influence of pregnancy and lactation on renal calcium indices, such as the CCCR. To avoid diagnostic error of women with hypercalcemia during pregnancy and lactation, calcium biochemistry of first-degree relatives and genetic testing of select patients are recommended.

CML In Pregnancy: A Case Report Using Leukapheresis and Literature Review

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5177-5177 ◽  
Author(s):  
Yellu Mehander ◽  
Stephen Medlin
Keyword(s):  
Blood Cell ◽  
Interferon Alpha ◽  
White Blood Cell ◽  
Bed Rest ◽  
First Trimester ◽  
Myelogenous Leukemia ◽  
Cytotoxic Agents ◽  
Second Trimester ◽  
Wbc Count ◽  
In Pregnancy

Abstract Chronic myelogenous leukemia (CML) complicating pregnancy is rare and managing this specific subgroup of patients is challenging due to very limited data on this patient group. Management options differ depending on control of the CML at the time of the pregnancy. Patients who become pregnant during CML treatment with a TKI have been managed with watchful waiting, as well as Interferon-alpha, hydroxyurea, leukapheresis, and continuing tyrosine kinase inhibitors (TKI’s). Patients with concurrent diagnosis of CML and pregnancy present a more difficult management dilemma. In the absence of prospective trials, treatment has been tailored to individual patient needs and goals as well as past individual physician experience. The literature for treatment of CML in pregnancy is reviewed and a relevant case discussed. A 37 y/o woman with past medical history five miscarriages and asymptomatic mitral valve prolapse, presented for a routine visit in her first trimester. She complained of fatigue. CBC showed white blood cell (WBC) count at 189,000 with bone marrow consistent with CML and FISH positive for BCR-ABL. Patient was offered elective abortion but declined. She was started on interferon, 90mcg per week, which was then increased to 135mcg/week after about 3 weeks. Her elevated WBC count persisted and her symptoms as well. Second opinion led to initiation of leukapheresis mid-second trimester with an empiric goal of less than 100,000. She underwent once weekly leukapheresis without significant complications and within four weeks, her white blood cell count dropped to between 50,000 and 75,000, with hemoglobin between 8.5 and 9.7 and platelets of 450,000 to 550,000 until week 32. Her fatigue improved. She had been found to have a small placental abruption at her ultrasound in the second trimester prior to leukapheresis. This led to spotting and bed rest at 32 weeks. She delivered at 35 weeks with a healthy fetus. She had a pulmonary embolus complicating her period of bed rest. Pregnancy diagnosed concurrently with CML is uncommon and difficult to treat due to limited available options and lack of enough data about the potential harm to the fetus. Termination of pregnancy is considered safe for the mother when caught in the first trimester but was not desired in this case. Treatment during the second trimester with agents such as TKI’s is reported to be associated with fetal malformations. Interferon alpha therapy is FDA approved as category C in pregnancy, but can work slowly. Leukapheresis is thought to involve minimal risk to the fetus and minimize risk of complications of hyperleukocytosis. The effect of Leukapheresis is transient; therefore chance of rebound is high in rapidly proliferating leukemia. Successful use of leukapheresis has been reported in a few case reports. No specific guidelines have been developed to manage this specific group of patients. Use of TKI and other cytotoxic agents may be safer in third trimester but since enough data is not available to date, use of these agents cannot be recommended as routine therapy. Use of cytotoxic agents such as hydroxyurea may also be reasonable but also are not FDA approved for use. Leukapheresis may be a safe procedure to use in select situations when preservation of the fetus is desired, particularly during hyperleukocytosis. This procedure has very few complications and no major complications have been reported in the literature. Our patient had a PE after 2 weeks of strict bedrest in the hospital. This was not thought to be directly related to the underlying CML. The newborn was healthy at birth and the mother was treated with a TKI two weeks after delivery. Disclosures: No relevant conflicts of interest to declare.

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