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Background Juvenile primary hyperparathyroidism (PHPT) is a rare endocrine disease. Its diagnosis might be masked by clinical, biochemical, and radiological features of rickets. Case presentation A 12-year-old Sudanese boy presented with progressive lower limbs deformity and difficulty in walking for six months. It was associated with fatigability, poor appetite, and generalized bone pain. On examination, he was thin, disproportionately short and pubertal, and had bilateral genu valgum deformity. X-rays showed osteopenia and signs of rickets. Biochemical workup revealed mildly elevated serum calcium, low phosphate, high alkaline phosphatase, and high parathyroid hormone with low 25-hydroxy vitamin D3. Celiac screening, liver function test and renal profile were normal. Serum calcium rose dramatically after vitamin D therapy. Genetic testing was negative for CYP2R1 and MEN1 genes. Ultrasound neck showed left inferior parathyroid adenoma which was surgically excised. Histopathology confirmed the diagnosis of parathyroid adenoma. Postoperatively, he had hypocalcemia which was treated with calcium and alfacalcidol. Corrective surgery is planned for the genu valgum deformity which markedly improved after parathyroidectomy. Conclusion Although PHPT is extremely rare in the young population, it should be considered in patients with rickets and elevated serum calcium at baseline or after initiating vitamin D therapy.

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<b><i>Background:</i></b> Graves’ disease (GD)-related bone marrow injury presents usually as agranulocytosis or less commonly as pancytopenia. However, acute lymphoblastic leukemia (ALL) has been reported recently in an adult patient with GD. The underlying pathogenesis is not fully understood. Nevertheless, the harmful effects of anti-thyroid drugs or autoimmune reaction to bone marrow cells are anticipated to be the causative factors. <b><i>Case Presentation:</i></b> We report a 16.5-year-old girl with GD who was on carbimazole for the first 14 months of her illness, with irregular follow-up; then it was withdrawn because she developed hypothyroidism. Meanwhile, she developed severe anemia without fever which necessitated blood transfusion. Eight months later, she presented with thyrotoxicosis relapse, febrile illness, bone pain, and pancytopenia which was proved to be ALL on bone marrow examination. <b><i>Conclusion:</i></b> The presence of ALL in a young GD patient is an unprecedented event. Although it is difficult to demonstrate the causality between them, need for further studies cannot be denied.

This chapter will talk about diabetes in African children living in Africa. It will cover diabetes, the classification in general, and the gray areas of diabetes in Africa. It will also cover part of the genetics of diabetes around Africa and its shortfall. The chapter will also look at the management of diabetes in an African setting, where insulin is stored in pots, and the challenges that a child with diabetes goes through in Africa. This chapter will be useful for pediatric endocrinologists, pediatricians, adult diabetologists, doctors, nurses, and everyone in the health sector dealing with children with diabetes.