Hyperparathyroidism during Pregnancy: What are the signs? What is the treatment?

Hyperparathyroidism during pregnancy is rare. The causes are the same as in nonpregnant women. A single parathyroid adenoma is the most common cause of hyperparathyroidism. In addition to the health complications and long-term effects of elevated calcium in the mother, the growing baby can also suffer serious complications. Hyperparathyroidism during pregnancy is an urgent matter and requires thorough evaluation by and endocrinologist.

The placenta allows transport of calcium from the mother's blood to the baby's blood. Therefore, when the mother has hypercalcemia, or too much calcium in the blood, the baby will also have hypercalcemia. Excess calcium in the baby's blood will suppress the development of the parathyroid gland, resulting in fetal hypoparathyroidism. The parathyroid glands may not fully develop and hypoparathryoidism in the baby may be permanent. After birth, the baby's parathyroid glands will not be able to produce normal levels of parathyroid hormone. Therefore, after birth, when the calcium source from the mother is eliminated, the baby will not be able to maintain proper calcium levels, resulting in hypocalcemia. This can result in tetany shortly after birth. Tetany is a syndrome characterized by muscular twitching, cramps, and seizures in severe cases.

Often, similar to non-pregnant patients, the mother is asymptomatic and does not realize she has hyperparathyroidism. Tetany in the baby may be the first sign that there was hyperparathyroidism in pregnancy. Although many women do not have symptoms, those that do may complain of muscle weakness, abdominal cramping and disorientation among others. The risk of obstetric complications is higher in women with hyperparathyroidism and includes abortion, stillbirth, prematurity, and intrauterine growth restriction. Because of these numerous complications, surgical treatment should not be postponed until after delivery.

The ideal time for surgery during pregnancy is the second trimester because the risk of preterm delivery is lower at this time. Although there are risks associated with all surgeries during pregnancy, the need for treatment for both the mother and baby outweighs the risks in this situation. Surgery is the only definitive treatment. If surgery is not possible, there are some medical treatments including fluids, diuretics or even hemodialysis to control calcium levels until after delivery.

Hyperparathyroidism during pregnancy is a serious condition. Thorough evaluation and treatment are very important for the health of both the mother and the baby.