Croom R D, Thomas C G
Surgery. 1984 Dec;96(6):1109-18.
Primary hyperparathyroidism during pregnancy is associated with significant risk of fetal loss and neonatal and maternal morbidity. Neonatal hypocalcemia probably results from transient hypoparathyroidism consequent to abnormal suppression by fetal hypercalcemia. Loss of the protective effect provided by the placental calcium transport mechanism produces significant maternal risk for development of acute hypercalcemia and possible crisis immediately postpartum. Management of maternal primary hyperparathyroidism diagnosed during pregnancy should be based on the patient's symptoms, severity of the disease, and gestational age of the fetus. Patients without symptoms and those with mild hypercalcemia may be managed effectively and safely for a short time with oral phosphate therapy, postponing operation until after delivery. More severe disease characterized by progressive symptoms and inadequately controlled hypercalcemia should be treated surgically after control of hypercalcemia has been achieved with diuretic and/or other medical therapy. Maternal operative morbidity is low and risk to the fetus is slight once organogenesis has been completed. Maternal parathyroidectomy should be performed preferably after the first trimester and should not be deferred unless delivery is imminent.
妊娠期原发性甲状旁腺功能亢进与胎儿丢失、新生儿及母亲发病的显著风险相关。新生儿低钙血症可能是由于胎儿高钙血症异常抑制导致的暂时性甲状旁腺功能减退所致。胎盘钙转运机制所提供的保护作用丧失，会使母亲面临急性高钙血症及产后即刻发生危机的重大风险。孕期诊断出的母亲原发性甲状旁腺功能亢进的管理应基于患者的症状、疾病严重程度及胎儿的孕周。无症状及轻度高钙血症的患者可通过口服磷酸盐疗法在短时间内得到有效且安全的管理，将手术推迟至分娩后。以进行性症状和控制不佳的高钙血症为特征的更严重疾病，应在通过利尿剂和/或其他药物疗法控制高钙血症后进行手术治疗。一旦器官形成完成，母亲手术的发病率较低，对胎儿的风险也较小。母亲甲状旁腺切除术最好在孕早期之后进行，除非即将分娩，否则不应推迟。
