A 10-year Retrospective Study of Primary Hyperparathyroidism in Children

Abstract

PHPT in children is rare, the commonest signs are urinary and bone tissue impairment, as well as non-specific signs. Evaluation of serum calcium and PTH levels is diagnostic in suspected patients. Preoperative localization is essential. Surgery is without significant complications. Surgical treatment of PHPT is curative and definitive.

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 Children and Adolescents

“…[6][7][8]10,[13][14][15][16][17][18] Remarkably, PHPT is clinically symptomatic in most young patients, who typically present with signs or symptoms of hypercalcemia, skeletal complications, and/or nephrolithiasis. Few if any young patients with PHPT are discovered incidentally to have asymptomatic hypercalcemia.…”

“…6 However, over the past 30 years several large pediatric case series were published that increased the number of reported cases of PHPT in this age group to more than 300. [7][8][9][10][11][12][13][14][15][16][17][18] The largest of the primary studies in this area comprises 55 patients, of whom 11 were infants with PHPT and 44 were young children or adolescents with PHPT. 13 The largest study focusing solely on childhood and adolescent PHPT includes 52 patients.…”