妊娠合并原发性甲状旁腺功能亢进症的诊治

Diagnosis and treatment of pregnancy with primary hyperparathyroidism

原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)是妊娠期罕见的合并症,发病率为0.03%~0.05%,临床表现各异,可累及多个器官和系统,某些方面与妊娠期的生理反应类似,不易区分。实验室检查表现为高钙血症、低磷血症、血甲状旁腺激素升高,孕期影像学检查首选颈部超声,可识别及定位异常甲状旁腺组织,磁共振成像检查对判断病变程度有帮助,应避免X线摄影及核素显像。手术切除病变甲状旁腺是孕期治疗PHPT的首选方案,手术时机以孕中期为宜,术后应注意预防孕妇及围产儿低钙血症。对于轻中度的PHPT可选择保守治疗,补液、扩容、利尿对于降低高钙血症有帮助,药物治疗因缺乏孕期用药的安全数据而受到严重限制。

Primary hyperparathyroidism (PHPT) is a rare complication of pregnancy. The incidence rate is about 0.03%-0.05%. The clinical manifestations are different and can involve multiple organs and systems. In some aspects, it is similar to the physiological response of pregnancy and is difficult to distinguish. The laboratory examination shows hypercalcemia, hypophosphatemia, and elevated blood PTH. Ultrasound is the preferred imaging examination during pregnancy, which can identify and locate abnormal parathyroid tissue. Magnetic resonance imaging helps determine the degree of the lesion, and X-ray imaging and nuclide imaging should be avoided. Parathyroidectomy is the first choice for the treatment of PHPT during pregnancy. The operation time should be in the second trimester of pregnancy. After the operation, attention should be paid to the prevention of hypocalcemia in pregnant women and perinatal infants. For mild to moderate PHPT, conservative management can be selected. Fluid replacement, volume expansion and diuresis are helpful in reducing hypercalcemia. Drug treatment is severely limited due to the lack of safety data for drug use during pregnancy.