Primary Hyperparathyroidism in Pediatric Patients

Abstract

The diagnosis of primary HPT in pediatric patients is frequently delayed, is commonly symptomatic, and has significant morbidity. For children in whom HPT is suspected, evaluation of serum calcium and PTH levels is diagnostic in 100% of children. Parathyroid resection is effective at restoring normal serum calcium, has few complications, and is the treatment of choice for children with primary hyperparathyroidism.

Parathyroid Surgery in Children

“…Patients with normal calcium levels over the long-term are said to be cured. The outcomes of pediatric patients after parathyroidectomy for HPT are similar to adults, with 96-100% cured in reported series (2)(3)(4).…”

“…In children and young adults with primary HPT, 60-92% have a single adenoma and 0-40% have four-gland hyperplasia (2)(3)(4). In both adults and children with primary HPT four gland hyperplasia is more common in patients with hereditary conditions such as Multiple Endocrine Neoplasia Type 1 (MEN1) (1,5) Patients with hyperparathyroidism can have a wide range of symptoms, or they can be asymptomatic (see Table 1) (2,4). Children are more likely to be symptomatic than adults.…”

“…Children are more likely to be symptomatic than adults. In most adult series 30-40% of patients are asymptomatic at presentation while in pediatric series only 0-20% of patients are asymptomatic at presentation (2,4,5). Children are also more likely to present with end organ damage, including pathologic bone fractures, osteitis fibrosa cystica, nephrolithiasis, and pancreatitis (4).…”

Primary hyperparathyroidism in childhood

“…Первый случай ПГПТ у ребенка описан в 1930 г., когда J. Pemberton и K. Geddie из клиники Мэйо, США, представили больную девочку в возрасте 14 лет [11]. С тех пор опубликовано около трехсот наблюдений ПГПТ у детей и подростков.…”

“…Как пра-вило, авторы сообщают о наблюдениях от одного до нескольких десятков случаев этого заболева-ния в детском и подростковом возрасте [1, 3-7, 9, 10, 12]. Наибольшее число наблюдений представле-но из клиники Мэйо -52 пациента до 19 лет [11], при этом у 2 больных аденомы ОЩЖ диагности-рованы в составе синдрома МЭН 2а типа (синдром Сиппла), у одного пациента выявлен семейный ва-риант ПГПТ.…”