Dr Dianna Luong1,2, Dr Fiona Britten1,2, Dr Lauren Fernandes1, Associate Professor Karin Lust1,2, Dr Jane Rigg2, Dr Penny Wolski1,2
1Royal Brisbane and Women's Hospital, Herston, Australia, 2University of Queensland – School of Medicine, Herston, Australia
Biography:
Dr Dianna Luong is an Endocrinologist and Obstetric Medicine Physician in Brisbane. She completed her training at the Royal Brisbane and Women’s Hospital, where she remains involved in research. She is passionate about improving antenatal healthcare accessibility and is working on expanding the antenatal endocrinology service at Logan Hospital.
Abstract:
Introduction: Primary hyperparathyroidism in pregnancy is associated with significant morbidity and optimal treatment remains unclear. We previously published a single-centre series of 28 individuals with hyperparathyroidism in pregnancy from 2000-2015. We have now extended this cohort with analysis of the subsequent 7 years (2016-2022). This is the largest single-centre study assessing maternal-fetal outcomes in primary hyperparathyroidism.
Methods: Twenty-five women (n=26 pregnancies) with primary hyperparathyroidism diagnosed prior to or during pregnancy were identified via diagnosis related group (DRG) coding and elevated calcium levels in pregnancy between 2016-2022. Medical records were scrutinised by the investigators to confirm the diagnosis. The demographics, biochemistry, medical intervention, and maternal-fetal outcomes were evaluated. A pooled analysis with previous 5-year data was conducted (n=54) to evaluate the change in practice over a 12-year period. Non-parametric data analysis was performed on SPSS software.
Results: From 2016-2022, the median gestational age at diagnosis of primary hyperparathyroidism was 15.1 weeks (IQR=17.0). The median serum corrected calcium and PTH at diagnosis were 2.7mmol/l (IQR=0.19) and 6.6pmol/L (IQR=5.65), respectively. Of the 26 cases, 7 underwent a parathyroidectomy in pregnancy (26.9%). Corrected calcium and PTH at time of diagnosis were higher in those who had surgery in pregnancy (p=0.02 and p=0.01, respectively). A higher proportion of individuals medically managed developed preeclampsia (26.3%); an observation previously noted. Furthermore, all emergency caesarean sections occurred in women who were medically managed. No change in median gestation at delivery and neonatal birth weights were noted between the surgical and non-surgical groups (p>0.05). Pooled data analysis of 54 cases yielded similar results (p>0.05).
Conclusion: Our data provides ongoing evidence for good pregnancy outcomes in women who undergo parathyroidectomy in pregnancy.
Keywords
Primary hyperparathyroidism, parathyroid adenoma, hypercalcaemia
References
1. Appelman-Dijkstra NM, Pilz S. Approach to the Patient: Management of Parathyroid Diseases Across Pregnancy. J Clin Endocrinol Metab. 2023;108(6):1505-1513.
2. Rigg J, Gilbertson E, Barrett HL, Britten FL, Lust K. Primary Hyperparathyroidism in Pregnancy: Maternofetal Outcomes at a Quaternary Referral Obstetric Hospital, 2000 Through 2015. J Clin Endocrinol Metab. 2019;104(3):721-729.