Adem GÜNGÖR, Habib BİLEN, EMİN MURAT AKBAŞ, Çiğdem ÖZDEMİR, Bülent AKTAN

Gebelikte hiperparatiroidizm: İki olgu sunumu

Primer Hiperparatiroidizm (PHPT), gebelikte oldukça nadir görülen bir ancak hem anne hem de fetus için hayatı tehdit edici bir durumdur. Hiperemezis gravidarum kliniği ile karışması nedeni ile tanı koymak zordur. Tanıda laboratuvar olarak PTH ve kalsiyum yüksekliği ve fosfor düşüklüğü oldukça önemlidir. PHPT de radyolojik tanıda altın standart yöntem teknesyum-99m sestamibi sintigrafi yöntemidir. Ancak gebelerde kontrendike olduğu için kullanılmaz. Tanı alan gebe hastalar asemptomatik veya semptomatik olmalarına göre cerrahiye verilir veya medikal tedavi ile gebelik sonuna kadar takip edilirler. Cerrahi mümkünse ikinci trimester de yapılmalıdır. Bu yazıda gebelik sırasında tanı alan iki primer hiperparatiroidizm olgusu sunulmuştur.

Hyperparathyroidism in pregnancy: Report of two cases

Primary hyperparathyroidism is a quite rare, life-threatening situation for mother and fetus in pregnancy. The diagnosis is difficult when hyperemesis gravidarum is present. At diagnosis, the increase in PTH and calcium level and the decrease in phosphorus level is quite important. The gold Standard in radiological diagnosis is technetium-99m sestamibi scintigraphy screening method. However, it is contraindicated in pregnancy. Previously diagnosed pregnant women are given to surgery if they are symptomatic if they asymptomatic they are followed up until the end of pregnancy by medical treatment. If it is possible surgical procedure most be performed in the second trimester of pregnancy. In this report, two patients with hyperparathyroidism that diagnosed during pregnancy are presented.

PDF

___

1. Palmer M, Jakobsson S, Åkerström G, et al. Prevalence of hypercalcemia in a health survey: a 14-year follow-up study of serum calcium values. Eur J Clin Invest 1988;18:39-46.
2. Jorde R, Bönaa KH, Sundsfjord J. Primary hyperparathyroidism detected in a health screening. The Tromsö study. J Clin Epidemiol 2000;53:1164-1169.
3. Christensson T, Hellström K, Wengle B, et al. Prevalence of hypercalcemia in a health screening in Stockholm. Acta Med Scand 1976;200:131-137.
4. Schnatz, P.F. & Curry, S.L. Primary hyperparathyroidism in pregnancy: evidence-based management. Obstet Gynecol Surg 2002;57:365-376.
5. Cemeroglu AP, Bober E, Buyukgebiz A. Prolonged hypocalcemia in a 2 month-old boy unmasking maternal diagnosis of primary hyperparathyroidism. J Pediatr Endocrinol Metab 2001;14:785-787.
6. Heath H, Hodgson SF, Kennedy MA. Primary hyperparathyroidism. Incidence, morbidity, and potential economic impact in a community. N Engl J Med 1980;302:189-193.
7. Sato, K. Hypercalcemia during pregnancy, puerperium, and lactation: review and a case report of hypercalcemic crisis after delivery due to excessive production of PTH-related protein (PTHrP) without malignancy (humoral hypercalcemia of pregnancy). Endocr J 2008;55:959-966.
8. Kokrdova Z. Pregnancy and primary hyperparathyroidism. J Obstet Gynaecol 2010;30:57-59.
9. Carella MJ, Gossain VV. Hyperparathyroism and pregnancy: case report and review. J Gen Intern Med 1992;7:448-453.
10. Kelly TR. Primary hyperparathyroidism during pregnancy. Surgery 1991;110:1028-1031.