Protean presentations of parathyroid adenoma in childhood

Dey, Subrata Kumar; Beawarwala, Aziz; Gupta, Saikat Das

doi:10.4103/0971-9261.194620

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…At present, therapeutic methods allow for normalizing plasma electrolytes before surgery and the incidence of hypercalcemic storm and surgical complications has decreased to 2.8%. In addition, imaging studies (parathyroid scintiscan) and intraoperative PTH monitoring have increased the effectiveness of surgical treatment of parathyroid adenomas up to 92% [2]. Postoperatively, such patients, especially individuals with bone complications, require endocrinological treatment with calcium and vitamin D preparations due to the risk of hypocalcemia associated with the hungry bone syndrome [8].…”

Section: Discussionmentioning

confidence: 99%

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Bilateral slipped capital femoral epiphysis as first manifestation of primary hyperparathyroidism in a 15-year-old boy

Roztoczyńska

Wójcik

Konturek

et al. 2020

pedm

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Primary hyperparathyroidism (PHP) in children is a rare condition and has a very dynamic course with nonspecific symptoms, what complicates the diagnosis and delays PHP treatment. Case presentation: A 15-year-old boy was admitted to the Orthopedic Ward with the diagnosis of juvenile bilateral slipped capital femoral epiphysis and valgus deformities. Gait disturbances, limb pains and valgus knee deformities, polyuria, polydipsia and weight loss, have been increasing for 8 months. Despite the hypercalcemia found in laboratory tests and bone destruction demonstrated in computed tomography of the hips, orthopedic correction was performed. In histopathological examination -brown bone tumors. The PTH concentration was determined (PTH -589.1 pg/ml; (N: 10-60) and the child was referred to the Department of Pediatric Endocrinology, where severe hypercalcemia (Ca -4.07 mmol/l, N: 2.2-2.84) and hypophosphatemia (P -0.68 mmol/l; N: 0.95-1.75) and adenoma of the left lower parathyroid gland was diagnosed. Forced diuresis, loop diuretics and pamidronic acid were used to obtain normocalcemia. The complications of hypercalcemia were excluded; diagnostic management excluding multiple endocrine neoplasia type 1 and 2a (MEN 1 and MEN 2A) syndrome were performed. The child was referred to the Department of Endocrinological Surgery, where the adenoma of the left inferior parathyroid gland was resected. Conclusions: 1) Patients with PHP should be diagnosed of the condition based on clinical symptoms. In patients with specific symptoms, it is necessary to determine serum Ca levels, especially prior to the surgical procedures. 2) In each case of PHP, determinations should be made of blood PTH, Ca and P and detection of MEN 1 and MEN 2A syndromes. 3) Patients with hyperparathyroidism require management of multiorgan complications of hypercalcemia. 4) Following surgical treatment of parathyroid adenoma, longterm endocrinological follow-up is necessary.

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Section: Discussionmentioning

confidence: 99%

“…Primary hyperparathyroidism (PHP) is a condition that is exceptionally rare in developmental age, its incidence in children is 2-5/100,000 [1][2][3][4][5]. Hyperparathyroidism is a complex of clinical symptoms where the predominating element is hypercalcemia resulting from excessive PTH production [6].…”

Section: Introductionmentioning

confidence: 99%

Bilateral slipped capital femoral epiphysis as first manifestation of primary hyperparathyroidism in a 15-year-old boy

Roztoczyńska

Wójcik

Konturek

et al. 2020

pedm

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“…[ 1 2 ] The incidence of PHPT in children on the other hand is far lesser in children, contributing to 2-5 per 1 lakh children. [ 3 ] Symptoms in adolescents are usually atypical as compared to adults and may lead to delays in diagnosis. [ 4 ] The general perception is that the most common cause of PHPT in the younger age group is parathyroid hyperplasia and they are treated accordingly.…”

Section: Introductionmentioning

confidence: 99%

Primary Hyperparathyroidism in Young and Adolescents: Alike or Unlike Adult Hyperparathyroidism? - A Series from South India

Sadacharan,

Rao,

Mahadevan

et al. 2024

Indian Journal of Endocrinology and Metabolism

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Background: Primary hyperparathyroidism (PHPT) is a common endocrine condition but rare in the pediatric and adolescent populations. The presentations can be unique, accounting for significant morbidity in the case of untimely detection. Aim: To study surgically treated pediatric PHPT retrospectively. Methods: Surgically treated children of PHPT up to 20 years of age between 2010 to 2022 were analyzed. All of them were operated on by an endocrine surgeon and team. Results: There was a total of 712 parathyroidectomies over 12 years, out of which there were 52 children (7.3%) had PHPT at less than 20 years of age. This group included 32 male children. The mean age was 16.1 years, including 7 cases of neonatal severe HPT. Multiple Endocrine Neoplasia type 1 was confirmed in 12 children. Presentations were more severe like bone pain (35.13%), renal stones (27.02%), incidental asymptomatic detection (18.9%), failure to thrive (10.8%), and pancreatitis (8.1%) as compared to adults. Mean serum calcium was 12.9 mg/dl (highest-14.1, N-8.8-10.8 mg/dl), mean parathormone levels were 386.91 pg/ml (N-10-65) and vitamin D levels ranged from 2.9-22.8 ng/ml. Localization was done with ultrasound and 99mTc- SESTAMIBI scans. Mean serum calcium levels in NSPHPT were 28.6 mg/dl (N-8.8-10.8 mg/dl). There were a total of 45 cases (6.32%) of PHPT less than 20 years of age, excluding the cases of NSPHPT. All children underwent parathyroidectomy, with 14 cases having an additional thymectomy, 2 cases with thyroidectomy, and a single case of hemithyroidectomy. The cure rate was 97.3%, while one baby with NSPHPT had persistent disease (postop PTH-110 pg/ml). The uniglandular disease was seen in 54.05% and the rest had a multiglandular disease. Adults accounted for 559/660 cases with 80% uniglandular disease. All cases had a postoperative histopathological confirmation with an average follow-up of 1 year. Conclusion: Childhood PHPT has a few features same as the adult population. Symptomatic presentations like adults, though pancreatitis and fatigue were more commonly seen as compared to bone pain. Calcium, phosphorus, and parathormone levels were comparable. Uniglandular involvement was seen just like the adult population. There are a few others that make them a distinct subtype like their symptoms of bone pain and being more common among boys. One-fourth of them had MEN1. Fewer cases in this age group make them unique.

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