Surgical management of primary hyperparathyroidism during pregnancy: a systematic review of the literature

Abstract

Objective

Gestational primary hyperparathyroidism (PHPT) is an endocrinological disorder with serious outcomes for both women and neonates. The aim of our study was to present the current evidence concerning the perioperative outcomes of pregnant women with PHPT who underwent parathyroidectomy during pregnancy.

Methods

A meticulous systematic review of the literature published before February 2020 and all studies which presented perioperative and pregnancy outcomes off pregnant women who underwent parathyroidectomy for PHPT, were included.

Results

A total of 53 were finally included, which reported 92 pregnant women who had parathyroidectomy during their pregnancy. A total of 46 patients were hospitalized due to significant complications of PHPT before their parathyroidectomy. With regards to surgical approach, 52.2% of patients underwent minimally invasive parathyroidectomy (MIP), while bilateral neck exploration (BNE) was 41.3% of cases. Only 4 women was not cured, whereas transient hypocalcemia was occurred in 18 patients. All cases proceeded to deliveries of healthy neonates, after their parathyroidectomy.

Conclusions

Parathyroidectomy during pregnancy is a safe and effective treatment option with minimum complications and probably should be considered as the treatment of choice in specific group of pregnant women with PHPT.

妊娠期原发性甲状旁腺功能亢进症的外科治疗：文献系统综述 摘要

目的：妊娠期原发性甲状旁腺功能亢进症（PHPT）是一种对孕妇和新生儿有严重后果的内分泌紊乱疾病。我们研究的目的是提供关于妊娠期接受甲状旁腺切除术的PHPT孕妇围手术期结局的最新证据。

方法：对2020年2月之前发表的文献进行了细致、系统的综述, 并对所有关于接受甲状旁腺切除术治疗PHPT的孕妇的围手术期和妊娠结局的研究进行了综述。

结果：最终纳入了53项研究, 其中92名孕妇在妊娠期间接受了甲状旁腺切除术。共有46名患者在接受甲状旁腺切除术前因PHPT的严重并发症而住院。手术入路方面, 微创甲状旁腺切除术（MIP）占52.2%, 双侧颈探查（BNE）占41.3%。仅4例未治愈, 18例出现一过性低钙血症。所有病例在甲状旁腺切除术后继续分娩了健康新生儿。

结论：妊娠期甲状旁腺切除术是一种安全有效、并发症最少的治疗方案, 可能应被认为是特定的妊娠期PHPT的首选治疗方法。

Keywords:

• Primary hyperparathyroidism
• pregnancy
• gestational hyperparathyroidism
• parathyroidectomy

Author contributions

CN and AP designed the study. IM and FS contributed to data collection and assessment of quality of the studies. AP and IM wrote the first draft. SK, MP, VL and EP contributed to data interpretation, drafting and critical revision of the manuscript.

Disclosure statement

The authors report no conflict of interest.

Data availability statement

The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.