Pal Rimesh, Mukherjee Soham, Prasad Trupti N, Bhadada Sanjay Kumar
Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
Department of Endocrinology, TNMC and BYL Nair Hospital, Mumbai 400008, India.
Best Pract Res Clin Endocrinol Metab. 2025 Mar;39(2):101983. doi: 10.1016/j.beem.2025.101983. Epub 2025 Feb 27.
Primary hyperparathyroidism (PHPT) in pregnancy is rare. The physiological changes that occur in pregnancy often tend to mask the symptoms of PHPT, thereby making diagnosis challenging. If left undiagnosed, PHPT can lead to significant feto-maternal morbidity, which, primarily depends on maternal serum calcium levels. Maternal serum calcium > 11.4 mg/dl increases the risk of incident maternal and fetal complications. The diagnosis of PHPT in pregnancy is based on the documentation of parathyroid hormone-dependent hypercalcemia. Ultrasonography can be safely used to localize the culprit parathyroid lesions; other imaging modalities entailing the risk of exposure to ionizing radiation should preferably be avoided. Treatment involves parathyroid surgery (preferably performed in the second trimester) and/or medical management (hydration, use of calcium-lowering drugs like calcitonin and/or cinacalcet) and should be tailored to the term of pregnancy, severity of hypercalcemia, potential maternal-foetal risks involved, available surgical expertise and patient's choices.
妊娠合并原发性甲状旁腺功能亢进症（PHPT）较为罕见。孕期发生的生理变化往往会掩盖PHPT的症状，从而使诊断具有挑战性。如果未被诊断出来，PHPT会导致严重的母婴发病，这主要取决于母体血清钙水平。母体血清钙>11.4mg/dl会增加母体和胎儿发生并发症的风险。妊娠合并PHPT的诊断基于甲状旁腺激素依赖性高钙血症的记录。超声检查可安全用于定位甲状旁腺病变；应尽量避免使用其他有电离辐射暴露风险的成像方式。治疗包括甲状旁腺手术（最好在孕中期进行）和/或药物治疗（补液、使用降钙素和/或西那卡塞等降钙药物），治疗方案应根据孕周、高钙血症的严重程度、潜在的母婴风险、现有的手术专业知识和患者的选择进行调整。
