Kelly T R
Department of Surgery, Northeastern Ohio Universities College of Medicine, Akron City Hospital 44304.
Surgery. 1991 Dec;110(6):1028-33; discussion 1033-4.
Historically, primary hyperparathyroidism during pregnancy was associated with significant risk of maternal morbidity and fetal death. Maternal hypercalcemia results in fetal hypercalcemia, leading to suppression of fetal parathyroid gland function. Neonatal hypocalcemia with tetany is a common occurrence after birth when maternal calcium flow is interrupted. From 1930 to 1990, 109 cases of women with primary hyperparathyroidism associated with pregnancy have been reported, 39 of whom were treated surgically before delivery. Although fetal mortality rates for medically treated women have improved, fetal morbidity continues to remain higher than in women who undergo surgical treatment of parathyroid disease during pregnancy. Of 850 patients treated surgically for primary hyperparathyroidism since 1960, 12 were pregnant. Four of the patients were treated medically during pregnancy and underwent surgery after delivery; all four infants had neonatal hypocalcemia and tetany. The remaining eight patients were treated surgically during pregnancy: six in the second trimester and two (one with associated pancreatitis and one with hypercalcemic crisis) during the first trimester. There was no fetal or maternal morbidity or death in the surgical group. Parathyroid adenomas were present in 10 of the patients, hyperplasia in one, and parathyroid carcinoma in one. The management of maternal primary hyperparathyroidism diagnosed during pregnancy should be based on the patient's symptoms and severity of disease. Hyperparathyroidism characterized by progressive symptoms should be treated surgically, preferably during the second trimester. Symptom-free patients and those with mild hypercalcemia diagnosed in the third trimester may be managed medically, postponing operation until after delivery.
从历史上看，妊娠期原发性甲状旁腺功能亢进与孕产妇发病和胎儿死亡的重大风险相关。孕产妇高钙血症会导致胎儿高钙血症，进而抑制胎儿甲状旁腺功能。当母体钙流动中断时，新生儿低钙血症伴手足搐搦在出生后很常见。从1930年到1990年，共报告了109例与妊娠相关的原发性甲状旁腺功能亢进女性病例，其中39例在分娩前接受了手术治疗。尽管接受药物治疗的女性胎儿死亡率有所改善，但胎儿发病率仍然高于妊娠期接受甲状旁腺疾病手术治疗的女性。自1960年以来，850例接受原发性甲状旁腺功能亢进手术治疗的患者中，有12例怀孕。其中4例患者在孕期接受药物治疗，产后接受手术；所有4例婴儿均出现新生儿低钙血症和手足搐搦。其余8例患者在孕期接受手术治疗：6例在孕中期，2例（1例伴有胰腺炎，1例伴有高钙血症危象）在孕早期。手术组未出现胎儿或孕产妇发病或死亡情况。10例患者存在甲状旁腺腺瘤，1例为增生，1例为甲状旁腺癌。孕期诊断的孕产妇原发性甲状旁腺功能亢进的管理应基于患者的症状和疾病严重程度。以进行性症状为特征的甲状旁腺功能亢进应接受手术治疗，最好在孕中期进行。无症状患者以及在孕晚期诊断为轻度高钙血症的患者可进行药物治疗，将手术推迟至产后。
