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Das D, Banerjee M, Kar A, Bhattacharyya R, Chowdhury S, Mukhopadhyay S. Variable presentation and outcomes of primary hyperparathyroidism in children and adolescents. J Pediatr Endocrinol Metab 2024; 37:668-672. [PMID: 38706116 DOI: 10.1515/jpem-2023-0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Primary hyperparathyroidism (PHPT) in paediatric and adolescent age group presents with some unique challenges for clinicians. While the disease in the adult counterparts presents with symptoms which are described quite extensively in literature, children/adolescents have manifestations which are quite different and severe compared to the former. The present case series aimed to highlight the peculiarities of presentation of PHPT in children and adolescents. CASE PRESENTATION In this case series, we present experience of 5 cases of PHPT in children and adolescents from our centre. We compared our data with the data already available in literature. We have also described salient presenting features of PHPT in individuals less than 19 years old previously reported in literature and pointed out the specificities of this disease at this age group. CONCLUSIONS PHPT in children and adolescents should be considered as a separate entity compared to that in adults, given its unique features, such as rachitic features, and severity of different presenting phenotypes. Persistence of rachitic features despite vitamin D correction, pancreatitis, bilateral nephrolithiasis and otherwise unexplained psychiatric abnormalities of insidious onset require greater clinical vigilance and serum/urine calcium testing to rule out this uncommon yet possible entity.
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Affiliation(s)
- Debaditya Das
- Department of Endocrinology, I.P.G.M.E.R and S.S.K.M Hospitals, Kolkata, India
| | - Mainak Banerjee
- Department of Endocrinology, I.P.G.M.E.R and S.S.K.M Hospitals, Kolkata, India
| | - Anish Kar
- Department of Endocrinology, I.P.G.M.E.R and S.S.K.M Hospitals, Kolkata, India
| | - Rana Bhattacharyya
- Department of Endocrinology, I.P.G.M.E.R and S.S.K.M Hospitals, Kolkata, India
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Eze UJ, Elfadil S. A case report of primary hyperparathyroidism in an adolescent during Ramadan fast. SAGE Open Med Case Rep 2024; 12:2050313X241241439. [PMID: 38532850 PMCID: PMC10964445 DOI: 10.1177/2050313x241241439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Primary hyperparathyroidism is rare in children and usually presents with nonspecific symptoms. Ramadan fasting has been reported to unmask the diagnosis of primary hyperparathyroidism. A 15-year-old boy presented to the clinic for an emergency department follow up visit. He had started Ramadan fasting a week before his presentation to the clinic. He reported unintentional weight loss, abdominal pain, constipation, frequent headaches, exercise intolerance, tiredness, and palpitations. Physical examination was unremarkable except that he looked tired. Investigations revealed elevated calcium and parathyroid hormone, hypophosphatemia, low vitamin D, and parathyroid adenoma. He underwent parathyroidectomy, leading to a decrease in parathyroid hormone levels. He did well postoperatively, and by his 11-month follow-up visit, his calcium was back to a normal level, he was energetic, and had gained weight. A high index of suspicion is required to diagnose primary hyperparathyroidism in young patients, especially young Ramadan-fasting patients, who mostly present with vague nonspecific symptoms.
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Affiliation(s)
- Ujunwa Justina Eze
- Family Medicine Residency Program, WellSpan Good Samaritan Hospital, Lebanon, PA, USA
- Pediatric Medicine Clinic, WellSpan Pediatric Medicine – Cornwall Road, Lebanon, PA, USA
| | - Sundus Elfadil
- Pediatric Medicine Clinic, WellSpan Pediatric Medicine – Cornwall Road, Lebanon, PA, USA
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3
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Sadacharan D, Rao SS, Mahadevan S, Shanmugasundar G, Murthy S, Chandrashekaran S, Reddy VB, Ramji B. Primary Hyperparathyroidism in Young and Adolescents: Alike or Unlike Adult Hyperparathyroidism? - A Series from South India. Indian J Endocrinol Metab 2024; 28:22-28. [PMID: 38533276 PMCID: PMC10962777 DOI: 10.4103/ijem.ijem_150_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/24/2023] [Accepted: 06/25/2023] [Indexed: 03/28/2024] Open
Abstract
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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Affiliation(s)
- Dhalapathy Sadacharan
- Department of Endocrine Surgery, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India
- Endocrine and Breast Surgery, Department of Oncology, K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - Smitha S. Rao
- Endocrine and Breast Surgery, Department of Oncology, K S Hegde Medical Academy, Mangalore, Karnataka, India
| | - Shriraam Mahadevan
- Department of Endocrinology, Diabetes and Metabolism, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - G. Shanmugasundar
- Department of Endocrinology, KM Speciality Hospital, Chennai, Tamil Nadu, India
| | - S Murthy
- Department of Endocrinology, Endocrine Diagnostics, Chennai, Tamil Nadu, India
| | | | - Vijay Bhaskar Reddy
- Director and Consultant Endocrinologist, Vijay Centre for Diabetes and Metabolism, Puducherry, India
| | - Bharath Ramji
- Department of Endocrinology, Arka Centre for Hormonal Health, Chennai, Tamil Nadu, India
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4
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Boggs E, Szymusiak J. Common in Adults and Often Overlooked in Pediatrics: A Case Report of Primary Hyperparathyroidism in an Adolescent Patient. Cureus 2023; 15:e38112. [PMID: 37252573 PMCID: PMC10212720 DOI: 10.7759/cureus.38112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/23/2023] [Indexed: 05/31/2023] Open
Abstract
Primary hyperparathyroidism (pHPT) is a rare clinical entity in pediatric patients relative to adults. Consequently, the diagnosis is often delayed in pediatric patients, and children and adolescents are more likely to present with symptoms of hypercalcemia and end-organ damage. Here, we present the case of an adolescent patient with chest pain who was found to have a lytic bone lesion secondary to pHPT.
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Affiliation(s)
- Elizabeth Boggs
- Internal Medicine, University of Colorado School of Medicine, Aurora, USA
| | - John Szymusiak
- Internal Medicine-Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, USA
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Szabo Yamashita T, Gudmundsdottir H, Foster TR, Lyden ML, Dy BM, Tebben PJ, McKenzie T. Pediatric primary hyperparathyroidism: Surgical pathology and long-term outcomes in sporadic and familial cases. Am J Surg 2023; 225:699-702. [PMID: 36270819 DOI: 10.1016/j.amjsurg.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/24/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Primary Hyperparathyroidism (PHPT) is rare in pediatric patients. Data regarding surgical outcomes are scarce. METHODS Single-center retrospective review (1994-2020) of patients ≤21 years undergoing surgery for PHPT. RESULTS 66 patients were identified (61% female, 17 ± 3 years). 71% of patients were symptomatic at diagnosis. 32% of patients had known familial syndromes, most commonly MEN-1. 23% of patients without a known mutation had genetic testing, 22% positive. 56% of the total and 19% of the familial cohort underwent focused exploration. Single gland disease was found in 19% of familial vs 85% of sporadic cases, p < 0.00001. Persistence was 9%, all in the sporadic group, p = 0.11. Recurrence was 15%: 38% in the familial vs 2% in the sporadic groups, p=0.0004. Time to recurrence was 59 months (Q1-38, Q3-95), familial 61 vs 124 months sporadic, p=0.001. CONCLUSION Pediatric PHPT is frequently sporadic, although 5% of apparent sporadic cases are secondary to syndromes. Familial cases have higher rates of recurrence, requiring closer follow-up.
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Affiliation(s)
| | | | - Trenton R Foster
- Mayo Clinic, Department of Surgery, 200 1st Street SW, 55905, Rochester, MN, USA.
| | - Melanie L Lyden
- Mayo Clinic, Department of Surgery, 200 1st Street SW, 55905, Rochester, MN, USA.
| | - Benzon M Dy
- Mayo Clinic, Department of Surgery, 200 1st Street SW, 55905, Rochester, MN, USA.
| | - Peter J Tebben
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition and Department of Pediatric and Adolescent Medicine, 200 1st Street SW, 55905, Rochester, MN, USA.
| | - Travis McKenzie
- Mayo Clinic, Department of Surgery, 200 1st Street SW, 55905, Rochester, MN, USA.
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Bin Yahib SM, Algarni B, Alghamdi A, Nassan S. Primary Hyperparathyroidism as a Rare Cause of Unexplained Recurrent Abdominal Pain: Case Presentation and Literature Review. Cureus 2021; 13:e19155. [PMID: 34868788 PMCID: PMC8630508 DOI: 10.7759/cureus.19155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/30/2022] Open
Abstract
Abdominal pain is a common symptom in surgical practice. Around 11%-45% of pediatric population present with abdominal pain. In 29%-87.5% of pediatric population diagnosed with primary hyperparathyroidism (PHPT), abdominal pain and other gastrointestinal (GI) symptoms were the presenting complaint. Hyperparathyroidism is a condition characterized by increased parathyroid hormone (PTH) secretion. It usually presents with nonspecific symptoms of fatigue, poor appetite, weight loss, abdominal pain, nausea, emesis, and bone pain. We present a case of a 13-year-old girl who experienced a recurrent abdominal pain associated with nausea and vomiting, which was diagnosed eight months later when her laboratory investigation revealed high amylase, calcium, and PTH, which raised a suspicion of pancreatitis secondary to hyperparathyroidism. Imaging studies showed retrosternal lesion within the thymus gland, most likely a thymic parathyroid adenoma. The patient's symptoms resolved following thoracoscopic thymectomy, which was performed in another center. To assess the relationship between GI symptoms and PHPT, we reviewed 13 articles published between 2007 and 2020 in the English literature which reported 331 cases of primary PHPT and found that GI symptoms are the fourth most common presentation in patients with PHPT. In those patients, the reported incidence of GI symptoms including abdominal pain was 18.67%. Out of the 331 cases included, only one case mimicked our case as abdominal pain was the main presenting symptom. Unexplained recurrent abdominal pain should raise the suspicion for rare causes. Hyperparathyroidism should be included in the differential diagnosis of recurrent abdominal pain.
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Affiliation(s)
| | - Bader Algarni
- Pediatric Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Abdulaziz Alghamdi
- Pediatric Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Safi Nassan
- Pediatric Surgery, King Abdulaziz Medical City, Jeddah, SAU
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Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK). Langenbecks Arch Surg 2021; 406:571-585. [PMID: 33880642 DOI: 10.1007/s00423-021-02173-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS The purpose of this review is to provide updated recommendations for the surgical management of primary (pHPT) and renal (rHPT) hyperparathyroidism, formulating a new guideline of the German Association of Endocrine Surgeons (CAEK). METHODS Evidence-based recommendations for the diagnosis and therapy of pHPT and rHPT were assessed by a multidisciplinary panel using PubMed for a comprehensive literature search together with a structured consensus dialogue (S2k guideline of the Association of the German Scientific Medical Societies, AWMF). RESULTS During the last 20 years, a variety of new preoperative localization procedures, such as sestamibi-SPECT, 4D-CT, and various PET/CT procedures, were established for pHPT. High-resolution imaging, together with intraoperative parathyroid hormone (IOPTH) measurement, enabled focused or minimally invasive surgery to become the most favored surgical technique. Patients with pHPT and nonlocalizing imaging have a higher risk of multiglandular disease. Surgical therapy provides very high cure rates, with a clear relation to the surgeon's experience in parathyroid procedures. Reoperative parathyroidectomy, children with pHPT or familial forms, and parathyroid carcinoma are addressed and require special surgical expertise. A multidisciplinary team of experienced nephrologists, transplant, and endocrine surgeons should assess the diagnosis and treatment of renal HPT. CONCLUSION Surgery is the only curative treatment for pHPT and should be considered for all patients with pHPT. For rHPT, a more selective approach is required, and parathyroidectomy is indicated only when conservative treatment options fail. In parathyroid carcinoma, the adequacy of local resection influences local disease control.
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8
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Why is primary hyperparathyroidism more severe in children? Med Hypotheses 2021; 147:110482. [PMID: 33460993 DOI: 10.1016/j.mehy.2020.110482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 11/21/2022]
Abstract
The disease presentation of primary hyperparathyroidism (PHPT) is more severe in children. We hypothesize that this difference in disease presentation is a result of several factors including a delay in diagnosis, age-related differences in calcium metabolism and bone turnover, and the influence of the growth hormone (GH)/insulin growth factor-1 (IGF-1) axis. Only the first two explanations for the heightened disease severity of PHPT in children have been previously discussed in the literature. In regards to the potential role GH and IGF-1 may play in this disparity, previous studies have documented decreases in GH and IGF-1 secretion in symptomatic adult PHPT patients potentially influencing the severity of the patients' disease presentation. While these studies have yet to be replicated in the pediatric population, given that both GH and IGF-1 are important for the achievement of peak bone mass in young individuals, it is logical to infer that the GH/IGF-1 axis may be partly responsible for the severe presentation of PHPT in children.
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Gawrychowski J, Kowalski GJ, Buła G, Bednarczyk A, Żądło D, Niedzielski Z, Gawrychowska A, Koziołek H. Surgical Management of Primary Hyperparathyroidism-Clinicopathologic Study of 1019 Cases from a Single Institution. J Clin Med 2020; 9:jcm9113540. [PMID: 33147842 PMCID: PMC7693783 DOI: 10.3390/jcm9113540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism (pHPT) is an endocrine disorder characterized by hypercalcemia and caused by the presence of disordered parathyroid glands. Parathyroidectomy is the only curative therapy for pHPT, but despite its high cure rate of 95-98%, there are still cases where hypercalcemia persists after this surgical procedure. The aim of this study was to present the results of a surgical treatment of patients due to primary hyperparathyroidism and failures related to the thoracic location of the affected glands. METHODS We present a retrospective analysis of 1019 patients who underwent parathyroidectomy in our department in the period 1983-2018. RESULTS Among the group of 1019 operated-on patients, treatment failed in 19 cases (1.9%). In 16 (84.2%) of them, the repeated operation was successful. In total, 1016 patients returned to normocalcemia. CONCLUSIONS Our results confirm that parathyreoidectomy is the treatment of choice for patients with primary hyperparathyroidism. The ectopic position of the parathyroid gland in the mediastinum is associated with an increased risk of surgical failure. Most parathyroid lesions in the mediastinum can be safely removed from the cervical access.
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10
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Seo Y, Song K, Choi HS, Suh J, Kwon A, Chae HW, Kim HS. A case of primary hyperparathyroidism due to an intrathymic ectopic parathyroid adenoma in a 15-year-old boy. Ann Pediatr Endocrinol Metab 2020; 25:187-191. [PMID: 32871656 PMCID: PMC7538304 DOI: 10.6065/apem.1938172.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022] Open
Abstract
Hypercalcemia due to primary hyperparathyroidism (PHPT) is uncommon in children. PHPT is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas account for 6%-16% of all parathyroid adenomas and are rare in children but should be considered in cases that present with hypercalcemia. We report the case of a 15-year-old boy with PHPT due to an intrathymic ectopic parathyroid adenoma. Neck ultrasonography and Tc-99m-sestamibi (MIBI) scanning with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed ectopic parathyroid adenoma in the thymus. Video-assisted thoracoscopic surgery was performed to remove the ectopic parathyroid adenoma. Pathology showed intrathymic ectopic parathyroid adenoma. After surgery, the patient's serum calcium level immediately normalized. Intact parathyroid hormone (iPTH) and alkaline phosphatase levels returned to normal ranges within 3 months. Delayed diagnosis of PHPT can cause end-organ damage; a timely diagnosis is especially critical to preserve bone and renal function. If ectopic parathyroid adenomas are well localized in preoperative imaging evaluation and intraoperative iPTH level decreases after resection, ectopic parathyroidectomy without bilateral neck exploration may be performed to avoid unnecessary morbidity.
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Affiliation(s)
- Youngseok Seo
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungchul Song
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Han Saem Choi
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Junghwan Suh
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea,Address for correspondence: Ho-Seong Kim, MD, PhD Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-2069 Fax: +82-2-393-9118 E-mail:
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Zivaljevic V, Jovanovic M, Diklic A, Zdravkovic V, Djordjevic M, Paunovic I. Differences in primary hyperparathyroidism characteristics between children and adolescents. J Pediatr Surg 2020; 55:1660-1662. [PMID: 31706616 DOI: 10.1016/j.jpedsurg.2019.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND In children and adolescents, primary hyperparathyroidism (pHPT) is rare, associated with severe morbidity, and has different clinical characteristics than in adults. The aim of this study was to analyze differences in clinical and laboratory characteristics between children and adolescents with pHPT. METHODS A retrospective cohort study was conducted to analyze pHPT characteristics in young patients, who have been operated at our institution. All patients were divided into two groups: group of patients ≤15 years (children) and group of patients >15 and ≤20 years (adolescents). RESULTS Out of 1363 pHPT patients surgically treated during the study period, 14 patients (1%) were younger than 20 years: 6 children and 8 adolescents. Male-to-female ratio in children was 2:1, and in adolescents 1:1.7. Kidney stones were found in 62.5% of the adolescents and in none of the children patients. Bone form of the disease was the most frequent in children (in 83.1%), while in adolescents the kidney form was the most frequent (in 50%). Only 16.7% of children and 25% of adolescents did not have classical symptoms. All adolescent patients had single parathyroid adenoma, while 4 children patients had single parathyroid adenoma, one patient had hyperplasia, and one had parathyroid carcinoma. Both preoperative serum calcium and PTH levels were higher in children than in adolescents (3.87 mmol/L vs. 3.17 mmol/L; 812 ng/mL vs. 392 ng/mL, respectively). In all patients vitamin D level was low. All patients had normal postoperative values of serum calcium and PTH. CONCLUSION There is a significant difference in clinical and biochemical characteristics between children and adolescent pHPT patients. Therefore, these two groups should be analyzed and treated separately. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Vladan Zivaljevic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Milan Jovanovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Aleksandar Diklic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Vera Zdravkovic
- School of Medicine, Belgrade University, Serbia; University Children Hospital, Belgrade, Serbia
| | - Maja Djordjevic
- School of Medicine, Belgrade University, Serbia; Mother and Child Health Care Institute "Dr Vukan Cupic", Belgrade, Serbia
| | - Ivan Paunovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
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12
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Jovanovic M, Paunovic I, Zdravkovic V, Djordjevic M, Rovcanin B, Tausanovic K, Slijepcevic N, Zivaljevic V. Case-control study of primary hyperparathyroidism in juvenile vs. adult patients. Int J Pediatr Otorhinolaryngol 2020; 131:109895. [PMID: 31982848 DOI: 10.1016/j.ijporl.2020.109895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/18/2020] [Accepted: 01/18/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Primary hyperparathyroidism in juveniles is extremely rare condition, but in the last few decades the incidence is increasing. The aim of this study was to compare biochemical and clinical characteristics of juvenile and adult primary hyperparathyroidism patients. METHODS A retrospective case-control study was conducted from 2004 until 2017 in high volume endocrine surgery center. Juvenile group consisted of all primary hyperparathyroidism patients younger than 20 who have undergone parathyroidectomy, and two-fold more patients older than 20 were classified in control (adult) group. RESULTS A total of 14 patients with the age ≤20 years were included in the juvenile group, while 28 patients older than 20 were selected for the control group. Female-to-male ratio in juveniles was 1:1, and in adults 8:1 (p = 0.005). The most common form of the disease in juveniles was bone disease (42.9%) and most of adults were asymptomatic (39.3%). Mean preoperative serum calcium level was significantly higher in juveniles than in adults, 3.47 ± 0.74 mmol/L vs. 2.96 ± 0.25 mmol/L, p = 0.025. Mean preoperative PTH level was higher in juveniles than in control group, 572.6 ± 533.3 ng/L vs. 331.8 ± 347.5 ng/L, p = 0.089. CONCLUSION Clinical manifestations of primary hyperparathyroidism significantly differ in juvenile and adult patients. Juvenile primary hyperparathyroidism represents more severe form of the disease, often with end-organ damages, and it should be considered in patients with unspecific symptoms.
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Affiliation(s)
- Milan Jovanovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Ivan Paunovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Vera Zdravkovic
- School of Medicine, Belgrade University, Serbia; University Children Hospital, Belgrade, Serbia
| | - Maja Djordjevic
- School of Medicine, Belgrade University, Serbia; Mother and Child Health Care Institute "Dr Vukan Cupic", Belgrade, Serbia
| | - Branislav Rovcanin
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Katarina Tausanovic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Nikola Slijepcevic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
| | - Vladan Zivaljevic
- Center of Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine, Belgrade University, Serbia
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Abstract
BACKGROUND Since its first description, several studies have highlighted the role of the surgeon's experience in the outcome of parathyroid surgery, however, no uniform consensus exists regarding the minimum operative experience required for good surgical outcomes. This work aims to summarize the current data regarding the surgeon volume-outcome relationship for parathyroidectomy. METHODS An electronic literature review identified 85 publications, and after study selection 11 were included. An additional nine publications were added based on reference review and inclusion of publications not initially captured. CONCLUSIONS There are insufficient data to dogmatically conclude a minimum number of cases required to achieve optimal surgical results. However, extrapolation from the inclusive studies support the conclusions that higher operative volumes improve cure rates and decrease the rates of complications, recurrent disease, and perioperative costs. Endocrine Surgery fellowships or mentorships may help prepare the less experienced surgeon for successful outcomes. Although reticent to offer firm minimal volume requirements, we have made suggestions in this manuscript.
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Affiliation(s)
- Neeta J Erinjeri
- Endocrine Neoplasia Institute, Miami Cancer Institute, Miami, FL, USA.
| | - Robert Udelsman
- Endocrine Neoplasia Institute, Miami Cancer Institute, Miami, FL, USA; Florida International University, Miami, FL, USA; Yale University School of Medicine, New Haven, CT, USA.
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14
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Zivaljevic VR, Jovanovic MD, Djordjevic MS, Diklic AD, Paunovic IR. Case report of parathyroid carcinoma in a pediatric patient. Int J Pediatr Otorhinolaryngol 2019; 124:120-123. [PMID: 31185342 DOI: 10.1016/j.ijporl.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/01/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022]
Abstract
Parathyroid carcinoma is extremely rare in pediatric population. The authors report a case of 15-year-old girl with extremely elevated serum calcium (4.1 mmol/L) and parathyroid hormone (1170 pg/mL), with palpable neck mass. After en bloc resection, the patient remained normocalcemic within the next 2 years. To the best of our knowledge, this is the fourteenth documented case of parathyroid carcinoma in patients younger than 16 years. Even though parathyroid carcinoma is very uncommon in children with good prognosis, this diagnosis has to be considered when a child has severe hypercalcemia, elevated parathyroid hormone and palpable neck mass.
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Affiliation(s)
- Vladan R Zivaljevic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine University of Belgrade, Serbia
| | - Milan D Jovanovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Maja S Djordjevic
- School of Medicine University of Belgrade, Serbia; Mother and Child Health Care Institute "Dr Vukan Cupic", Belgrade, Serbia
| | - Aleksandar D Diklic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine University of Belgrade, Serbia
| | - Ivan R Paunovic
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia; School of Medicine University of Belgrade, Serbia
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15
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Hill KA, Yip L, Carty SE, McCoy KL. Concomitant Thyroid Cancer in Patients with Multiple Endocrine Neoplasia Type 1 Undergoing Surgery for Primary Hyperparathyroidism. Thyroid 2019; 29:252-257. [PMID: 30608029 DOI: 10.1089/thy.2017.0675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Compared to those with sporadic primary hyperparathyroidism (SPHP), multiple endocrine neoplasia type 1 (MEN1) patients with primary hyperparathyroidism (MPHP) typically require more extensive dissection and have higher recurrence rates. Little is known about the risk of concomitant thyroid cancer in either setting. This study aimed to determine the rates and characteristics of thyroid cancer for MPHP versus SPHP patients undergoing parathyroidectomy. METHODS Patients with MPHP (diagnosed by clinical and/or genetic criteria) or SPHP who had initial or reoperative parathyroid exploration from 1967 to 2014 were identified via a prospective database. The thyroid cancer-specific data for MPHP patients (n = 29) were compared to a selected 2:1 age- and sex-matched SPHP cohort (n = 58) who all had concurrent thyroidectomy for any reason. Clinically significant thyroid cancer was defined as >1 cm in diameter. RESULTS In the MPHP group, 24/29 (83%) thyroidectomies were preoperatively unplanned versus 20/58 (34%) in the SPHP matched cohort (p < 0.01), and in this setting there was no difference in the rate of histologic thyroid cancer (3/24 [13%] vs. 5/20 [25%], p = 0.44). Histologic thyroid cancer was identified in 8/29 (28%) MPHP versus 27/58 (47%) SPHP patients (p = 0.11). Despite observed differences in the time period and extent of thyroidectomy, MPHP patients did not have an increased likelihood of thyroid cancer (surgery before 2005: odds ratio [OR] = 2.57, p = 0.09; total thyroidectomy: OR = 5.47, p < 0.01; MPHP: OR = 1.14, p = 0.83). All MPHP thyroid cancers were characterized as conventional papillary thyroid cancer (PTC), while thyroid cancers in SPHP patients included both PTC (66%) and follicular-variant PTC (34%). No MPHP patient had clinically significant thyroid cancer compared to an incidence of 15/58 (26%) in SPHP patients (p < 0.01). CONCLUSIONS Although patients with MEN1 have a substantial incidence of thyroid cancer (28%) and undergo more unplanned thyroidectomies during parathyroidectomy than do patients with SPHP, clinically significant thyroid cancer is proportionally uncommon.
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Affiliation(s)
- Katherine A Hill
- 1 Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Linwah Yip
- 2 Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sally E Carty
- 2 Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelly L McCoy
- 2 Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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16
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Morimoto H, Nakajima H, Mori J, Fukuhara S, Shigehara K, Adachi S, Hosoi H. Decrement in bone mineral density after parathyroidectomy in a pediatric patient with primary hyperparathyroidism. Clin Pediatr Endocrinol 2018; 27:81-86. [PMID: 29662267 PMCID: PMC5897583 DOI: 10.1297/cpe.27.81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/19/2017] [Indexed: 11/04/2022] Open
Abstract
Primary hyperparathyroidism (PHT) causes increased bone turnover, leading to reduction in bone mineral density (BMD). Parathyroidectomy is a definitive therapy and improves BMD in adult patients with PHT. However, there are no reports regarding alterations of BMD in pediatric or adolescent patients with PHT. Here, we report a case of a 13-yr-old boy with PHT who was referred to our institution for evaluation of hypercalcemia and hyperparathyroidism. Radiological investigation revealed an ectopic parathyroid adenoma below the right thyroid lobe. A minimally invasive radio-guided parathyroidectomy was successfully performed. We followed up the patient's BMD for three years both before and after parathyroidectomy. Over the course of three years, his BMD was steadily decreased, with z-scores of +0.506 at 13 yr and 9 mo, +0.162 at 14 yr and 9 mo, and -0.411 at 15 yr and 9 mo. BMD usually increases during peak height velocity in an adolescent and improves after parathyroidectomy in adult patients with PHT. However, our patient showed decreased BMD z-scores following parathyroidectomy. Therefore, the patient had an increased risk of fracture after parathyroidectomy and was followed up closely. Both height and BMD should be carefully evaluated after parathyroidectomy in pediatric and adolescent patients with PHT.
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Affiliation(s)
- Hidechika Morimoto
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisakazu Nakajima
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun Mori
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shota Fukuhara
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Shigehara
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsuke Adachi
- Department of Pediatrics, Fukuchiyama City Hospital, Kyoto, Japan
| | - Hajime Hosoi
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
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17
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Hanba C, Bobian M, Svider PF, Sheyn A, Siegel B, Lin HS, Raza SN. Perioperative considerations and complications in pediatric parathyroidectomy. Int J Pediatr Otorhinolaryngol 2016; 91:94-99. [PMID: 27863650 DOI: 10.1016/j.ijporl.2016.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate perioperative considerations and post-operative complications associated with parathyroidectomy in the pediatric population. METHODS The Kids' Inpatient Database 21 (KID) was searched for patients who underwent parathyroidectomy in 2009 and 2012. Patient demographics, hospital stay, associated charges, and post-operative adverse sequelae were evaluated in all patients and included patient comorbidity and additional procedure requirement analysis. RESULTS There were 182 patients extrapolating to 262 parathyroidectomies over the two years analyzed. Although a minority of patients were male (45.4%), these patients had greater rates of complications, length of stay, and hospital charges. Importantly, minorities and younger patients (≤15y) also had more complicated post-operative courses. The lengths of stay for patients experiencing post-operative altered mental status (18.7d), post-operative infection (15.5d), respiratory complications (19d), and cardiac complications (13d) were significantly increased compared to individuals without major complications (3.4d) (p < 0.001). Patients with pre-existing chronic kidney disease, dialysis-dependence, and bone sequelae (most commonly from hungry bone syndrome) also had significantly lengthier stays and greater associated costs. CONCLUSION Findings from this analysis can be included in a comprehensive pre-operative informed consent process between physicians and patients discussing perioperative considerations and potential complications of parathyroidectomy. Males, younger children, and patients with preexisting renal conditions experienced lengthier and more complicated hospital stays, suggesting the need for closer monitoring of these cohorts.
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Affiliation(s)
- Curtis Hanba
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael Bobian
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Peter F Svider
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Anthony Sheyn
- Department of Otolaryngology - University of Tennessee Health Science Center, Memphis, TN, USA; LeBonheur Children's Hospital, Department of Pediatric Otolaryngology, Memphis, TN, USA
| | - Bianca Siegel
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Children's Hospital of Michigan, Detroit Medical Center, Detroit, MI, USA
| | - Ho-Sheng Lin
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - S Naweed Raza
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
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