The changing pattern of diagnosing primary hyperparathyroidism in young patients

Abstract

Background Primary hyperparathyroidism (PHPT) is increasing in adults but rarely reported in young patients where routine blood work is obtained more judiciously. We aim to determine how PHPT is currently being diagnosed in young patients and examine surgical outcomes. Method We retrospectively analyzed PHPT patients 24 years of age or less who underwent parathyroidectomy from 2001 to 2014. Patients were divided into 2 time periods: 2001 to 2007 (A) and 2008 to 2014 (B). Incidentally, diagnosed patients lacked objective symptoms of PHPT and had no family history. Results Forty young patients met inclusion criteria: 16 in group A and 24 in group B. Those in group A compared with group B had similar mean age, preoperative calcium, and parathyroid hormone (P > .05). Incidental diagnosis was more common in the contemporary group (42% vs 25%, P = .001). Conclusions Current diagnosis of PHPT in young patients is increasingly incidental. This trend may be attributed to the more liberal use of labs in younger patients.

Primary hyperparathyroidism in Chinese children and adolescents: A single‐centre experience at Peking Union Medical College Hospital

“…Remission was defined as achieving normocalcaemia by at least 6 months postoperatively. Recurrence was defined as hypercalcaemia recurring after 6 months after parathyroidectomy . Clinical screening for MEN was routinely performed in PHPT patients in our centre.…”

Two Different Causes of Paediatric Hypercalcaemia

“…5,8 Generally, primary HPT is rare in children and adolescents, constituting less than 5% of all cases. [9][10][11][12] At the Johns Hopkins Children's Center in Baltimore, Maryland, USA, only 16 paediatric and adolescent patients history was normal. One week prior, a urinalysis had revealed proteinuria and microscopic haematuria and she had been provisionally diagnosed with a urinary tract infection and prescribed painkillers and amoxicillin/clavulanate by a general practitioner.…”

“…11 Currently, the diagnosis of primary HPT in children and adolescents is mostly incidental. 11,12 The most frequent manifestation of paediatric primary HPT is urolithiasis in 64% of cases, with other symptoms including limb pain, fractures, hypertension, fatigue and constipation. 1,[9][10][11][12] In the current case report, the second patient presented with renal colic and hypercalcaemia due to a single parathyroid adenoma.…”

“…11,12 The most frequent manifestation of paediatric primary HPT is urolithiasis in 64% of cases, with other symptoms including limb pain, fractures, hypertension, fatigue and constipation. 1,[9][10][11][12] In the current case report, the second patient presented with renal colic and hypercalcaemia due to a single parathyroid adenoma. Among children, primary HPT is mostly due to a parathyroid adenoma; however, it can also occur within the context of other syndromes, such as parathyroid hyperplasia in MEN types I and II and HPT with jaw tumours.…”

“…Among children, primary HPT is mostly due to a parathyroid adenoma; however, it can also occur within the context of other syndromes, such as parathyroid hyperplasia in MEN types I and II and HPT with jaw tumours. [9][10][11][12] While a 99 Tc-MIBI scan, neck ultrasound and MRI scan can help to localise a parathyroid adenoma, 99 Tc-MIBI SPECT is the most reliable method in this regard. 13,14 In cases of paediatric parathyroid adenomas, surgical removal is the only effective treatment for primary HPT.…”