Primary hyperparathyroidism in pregnancy: a current paradigm of diagnostics, treatment, and neonatal monitoring

Primary hyperparathyroidism during pregnancy is a rare but clinically significant condition associated with a high risk of complications for both the mother and the fetus. The disease is often asymptomatic or masked by physiological changes in calcium-phosphorus metabolism, which complicates timely diagnostics. Biochemical verification is based on the detection of parathyroid hormone-dependent hypercalcemia. Neck ultrasonography is the safest method for preoperative localization of parathyroid lesions, whereas using radionuclide and computed tomography imaging are limited due to potential fetal radiation exposure. Management strategies are determined by gestational age, the severity of hypercalcemia, and the presence of complications. Conservative measures include adequate hydration, limited use of calcitonin, and cinacalcet; however, their efficacy is limited and may be associated with risks for the newborn. Surgical treatment such as parathyroidectomy optimally performed in the second trimester of pregnancy remains to be the «gold» standard. Compared to conservative management, surgery is associated with a lower risk of spontaneous abortion, preterm delivery, neonatal hypocalcemia, and other complications. The postpartum period requires close patient monitoring due to potential sharp increase in serum calcium levels. Newborns require monitoring of blood ionized calcium level and preventive measures to avoid neonatal hypocalcemia.

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