Primary hyperparathyroidism in pregnancy: observations from the Indian PHPT registry

J Endocrinol Invest. 2021 Jul;44(7):1425-1435. doi: 10.1007/s40618-020-01441-z. Epub 2020 Oct 9.


Purpose: To present the data on primary hyperparathyroidism (PHPT) in pregnancy from India obtained from a large database maintained over 15 years.

Methods: We retrieved data of all women with gestational PHPT from the Indian PHPT registry between July 2005 and January 2020, and compared their clinical, biochemical, and other characteristics with age-matched non-pregnant women with PHPT.

Results: Out of 386 women, eight had gestational PHPT (2.1%). The common presenting manifestations were acute pancreatitis (50%) and renal stone disease (50%); two were asymptomatic. Five women (62.5%) had a history of prior miscarriages. Seven patients (88%) had preeclampsia during the present gestation. Serum calcium and intact parathyroid hormone (iPTH) were not statistically different from the age-matched non-pregnant PHPT group. Six patients with mild-to-moderate hypercalcemia were medically managed with hydration with/without cinacalcet while one patient underwent percutaneous ethanol ablation of the parathyroid adenoma; none underwent surgery during pregnancy. Mean serum calcium maintained from treatment initiation till delivery was 10.5 ± 0.4 mg/dl. One patient had spontaneous preterm delivery at 36 weeks; the remaining patients had normal vaginal delivery at term. None had severe preeclampsia/eclampsia. Fetal outcomes included low birth weight in three newborns (37.5%); two of them had hypocalcemic seizures.

Conclusion: The prevalence of gestational PHPT was 2.1% in this largest Indian PHPT cohort, which is higher than that reported from the West (< 1%). Gestational PHPT can lead to preeclampsia and miscarriage. Pregnant PHPT patients with mild-to-moderate hypercalcemia can be managed with hydration/cinacalcet; however, long-term safety data and large-scale randomized controlled trials are required.

Keywords: Cinacalcet; Gestational PHPT; India; PHPT in pregnancy; Primary hyperparathyroidism.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperparathyroidism, Primary / complications
  • Hyperparathyroidism, Primary / epidemiology*
  • India / epidemiology
  • Infant, Newborn
  • Pre-Eclampsia / etiology
  • Pre-Eclampsia / pathology*
  • Pregnancy
  • Pregnancy Complications / etiology
  • Pregnancy Complications / pathology*
  • Premature Birth / etiology
  • Premature Birth / pathology*
  • Prognosis
  • Registries / statistics & numerical data*