Surgical treatment for primary hyperparathyroidism in pregnancy: A clinical case
Background. Primary hyperparathyroidism is very rarely detected during pregnancy because of the paucity of clinical symptoms and the lack of its history. Medical management of hyperparathyroidism during pregnancy can lead to severe disorders in both the mother and the fetus.Ilyicheva E.A., Sinitsyn V.A., Chonskaya M.A., Rozhanskaya E.V.
A case report. The paper gives the results of examination and treatment in a 31-year-old pregnant woman with a complicated obstetric history. Severe hypercalcemia (more than 3.5 mmol/l) resistant to medical therapy, a high parathyroid hormone level, and a tumor of the left parathyroid gland threw no doubt about the diagnosis. The patient underwent parathyroid adenomectomy with intraoperative monitoring of the time course of changes in intact parathyroid hormone, resulting in the recovery of the patient, carrying of a pregnancy, and birth of a healthy baby.
Conclusion. The timely diagnosis and surgical correction of primary hyperparathyroidism in pregnancy is accompanied by elimination of the negative implications of the disease on the course of pregnancy and childbirth.
Keywords
primary hyperparathyroidism
surgical treatment
pregnancy
Supplementary Materials
- Fig. 1. Micrograph of operating material. Upper left parathyroid. Formation from monomorphic cells with a centrally located nucleus, with the formation of trabecular and solid structures. Hematoxylin and eosin. Increase 1х200
- Fig. 2. Micrograph of operating material. Upper left parathyroid. Monomorphic cell composition of the tumor, absence of adipose tissue in the tumor, presence of a thin capsule. Hematoxylin and eosin. Increase 1х200
References
1. Мокрышева Н.Г., Рожинская Л.Я., Перетокина Е.В., Ростомян Л.Г., Мирная С.С., Пронин В.С., Маркина Н.В., Шебешева Е.Н., Анциферов М.Б., Дедов И.И. Анализ 1970 основных эпидемиологических характеристик первичного гиперпаратиреоза в России (по данным регистра). Проблемы эндокринологии. 2012; 58(5): 16-20. [Mokryisheva N.G., Rozhinskaya L.Ya., Peretokina E.V., Rostomyan L.G., Mirnaya S.S., Pronin V.S., Markina N.V., Shebesheva E.N., Antsiferov M.B., Dedov I.I. The analysis of 1970 main epidemiological characteristics of primary giperparatireoz in Russia (according to the register). Problemy endokrinologii. 2012; 58(5): 16-20. (in Russian)]
2. Schnatz Р.F., Curry S.L. Primary hyperparathyroidism in pregnancy: evidence-based management. Obstet. Gynecol. Surv. 2002; 57(6): 365-76.
3. Walker A., Fraile J.J., Hubbard J.G. „Parathyroidectomy in pregnancy”-a single centre experience with review of evidence and proposal for treatment algorithim. Gland Surg. 2014; 3(3): 158-64. doi: 10.3978/j.issn.2227-684X.2014.02.04.
4. Herrera-Martínez A.D., Bahamondes-Opazo R., Palomares-Ortega R., Muñoz-Jiménez C., Gálvez-Moreno M.A., Quesada Gómez J.M. Primary hyperparathyroidism in pregnancy: a two-case report and literature review. Case Rep. Obstet. Gynecol. 2015; 2015: 171828. doi: 10.1155/2015/171828.
5. Rutkowska J., Bandurska-Stankiewicz E., Matuszewski W., Gowkielewicz M., Goraj R., Onichimowski D. Primary hyperparathyroidism in pregnancy - a diagnostic and therapeutic challenge. Endokrynol. Pol. 2015; 66(3): 270-4. doi: 10.5603/EP.2015.0034.
6. Hirsch D., Kopel V., Nadler V., Levy S., Toledano Y., Tsvetov G. Pregnancy outcomes in women with primary hyperparathyroidism. J. Clin. Endocrinol. Metab. 2015; 100(5): 2115-22. doi: 10.1210/jc.2015-1110.
7. Schnatz P.F., Thaxton S. Parathyroidectomy in the third trimester of pregnancy. Obstet. Gynecol. Surv. 2005; 60(10): 672-82.
8. Чигирьков Н.А., Сокологорский С.В., Шифман Е.М. Случай успешного проведения анестезии при оперативном родоразрешении больной с недиагностированным первичным гиперпаратиреозом тяжелого течения. Акушерство и гинекология. 2011; 4: 123-5. [Chigirkov N.A., Sokologorsky S.V., Shifman E.M. A case of successful anesthesia during surgical delivery in a patient with undiagnosed severe primary hyperparathyroidism. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2011; 4: 123-125. (in Russian)]
9. Есаян Р.М., Кан Н.Е., Шифман Е.М., Александровский А.В., Рожинская Л.Я., Талер Н.А., Мокрышева Н.Г., Дудинская Е.Н., Ткачева О.Н. Первичный гиперпаратиреоз во время беременности и послеродовом периоде Акушерство и гинекология. 2012; 8-1: 64-8. [Esayan R.M., Kan N.E., Shifman E.M., Aleksandrovsky A.V., Rozhinskaya L.Ya., Taler N.A., Mokrysheva N.G., Dudinskaya E.N., Tkacheva O.N. Primary hyperparathyroidism during pregnancy and postpartum. Akusherstvo i Ginekologiya/Obstetrics and gynecology. 2012; 8(1): 64-68. (in Russian)]
10. Barczyński M., Gołkowski F., Nawrot I. The current status of intraoperative iPTH assay in surgery for primary hyperparathyroidism. Gland Surg. 2015; 4(1): 36-43. doi: 10.3978/j.issn.2227-684X.2015.01.01.
Received 01.12.2016
Accepted 23.12.2016
About the Authors
Ilicheva Elena Alekseevna, manager of scientific department of surgery, Irkutsk Research Center of Surgery and Traumatology.664049, Russia, Irkutsk, mkr. Yubileynyiy, 100, p/o 15. Tel.: +73952407828. E-mail: lena_isi@mail.ru
Sinitsyin Vladimir Aleksandrovich, manager of the regional endocrinologic center, Irkutsk Regional Clinical Hospital.
664049, Russia, Irkutsk, mkr. Yubileynyiy, 100, p/o 15. Tel.: +73952407828. E-mail: sinicenva@mail.ru
Chonskaya Mariya Aleksandrovna, obstetrician-gynecologist of advisory diagnostic unit of the regional perinatal center, Irkutsk Regional Clinical Hospital.
664049, Russia, Irkutsk, mkr. Yubileynyiy, 100, p/o 15. Tel.: +73952407828. E-mail: marijaglbvt@yandex.ru
Rozhanskaya Elena Vyacheslavovna, pathologist, Irkutsk Regional Pathoanatomical Bureau.
664049, Russia, Irkutsk, mkr. Yubileynyiy, 100. Tel.: +73952465389, +73952465362. E-mail: rozha1974@mail.ru
For citations: Ilyicheva E.A., Sinitsyn V.A., Chonskaya M.A., Rozhanskaya E.V. Surgical treatment for primary yperparathyroidism in pregnancy: A clinical case.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (8): 121-4. (in Russian)
http://dx.doi.org/10.18565/aig.2017.8.121-4
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