Hyperparathyroidism in pregnancy, should we favour surgical intervention?

Adnan Zaina; Shezifi Eli

doi:10.1530/endoabs.90.P309

Primary hyperparathyroidism (PHPT) during pregnancy is an uncommon condition that may have consequences for either mother, offspring, or both. Treatment can be either surgical or conservative.

The study aims: To compare maternal and fetal adverse outcomes between surgically (operated group) vs conservatively (non-operated group) treated mothers with gestational PHPT and to investigate the correlation between serum calcium and PTH values with complication rates.

Methods: A systematic review of all cases of PHPT during pregnancy, published in peer-reviewed English literature on PubMed and ScienceDirect from 1990 to 2021, was conducted.

Results: 98 manuscripts were included in the study describing 368 cases of gestational hyperparathyroidism. 134 (36.4%) underwent parathyroidectomy, and 234 (63.6%) were treated conservatively. The mean age was 30.8 ± 5.5 and 31.6 ± 5.7, respectively. Median calcium levels were higher in the operated group, 12.2 mg/dl Vs. non-operated group 11.1 mg/dl (P<0.001). PTH values had a mean of 132.5 pg/ml and 122.7 pg/ml for the respective groups (P=0.126). Maternal and fetal complications were reported in 28.5% and 31% of cases. The rate of mild and moderate maternal complications was significantly higher in the operated group, reaching 50 (37.3%) compared to 40 (17.1%) in the non-operated group, respectively (P<0.01). Fetal complications were significantly lower in the operated group. With 8.2% vs.13.7% for mild, 4.5% vs. 9.4% for moderate, and 1.5 vs. 12.4% for severe complications, respectively (P<0.001). Favorable outcomes were obtained when the surgery took place during the second trimester. We identified a positive correlation between adverse maternal outcomes, serum calcium, and serum PTH values.

Table 1: Comparison of the outcomes between the operated and non-operated groups.
Maternal complications	None	Mild	Moderate	Severe	NR	P-value
Total study population (n=368)	263 (71.5%)	62 (16.8%)	28 (7.6%)	4 (1.1%)	11	<0.001
Non-operated group (n=234)	180 (76.9%)	25 (10.7%)	15 (6.4%)	4 (1.7%)	10
Operated group (n=134)	83 (61.9%)	37 (27.6%)	13 (9.7%)	0	1
Preoperative complications		24 (17.9%)	6 (4.4%)	0		0.23
Postoperative complications		13 (9.7%)	7 (5.2%)	0
Fetal complications
Non-operated group (n=234)	140 (59.8%)	32 (13.7%)	22 (9.4%)	29 (12.4%)	11	<0.001
Operated group (n=134)	114 (85.1%)	11 (8.2%)	6 (4.5%)	2 (1.5%)	1
Combined groups (n=368)	254 (69%)	43 (11.7%)	28 (7.6%)	31 (8.4%)	12
Abbreviations: NR=severity not reported.

Conclusions: Parathyroidectomy seems to be favorable over conservative management when postoperative maternal and fetal complications are considered.

Endocrine Abstracts

P309