Severe primary hyperparathyroidism diagnosed during pregnancy — particularly when serum calcium reaches or exceeds 2.7 mmol/L — represents a high-risk clinical scenario requiring prompt, carefully timed intervention to protect both the pregnant patient and the fetus.
This protocol addresses pregnant patients with confirmed severe primary hyperparathyroidism and a serum calcium level of ≥2.7 mmol/L. The combination of active pregnancy and significant hypercalcaemia narrows the window for safe intervention and constrains pharmacological options.
Severe cases in this setting are generally managed with a surgical approach at a specific window of gestation, using imaging to localise the source beforehand. Certain medical therapies used outside of pregnancy are not appropriate here due to safety constraints in the pregnant patient.
Normalisation of serum calcium levels following successful surgical intervention.
DOI: 10.1111/cen.14659
More severe cases generally should be operated, preferably in the second trimester.
When severe PHPT is diagnosed in pregnancy, parathyroidectomy is recommended in the second trimester, with ultrasound being the preferred localisation study.
Following successful surgery, provided residual parathyroid function is retained, serum calcium levels normalise.
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