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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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de Silva NL, Jayalath MD, Sampath WKC, Perera R, Karunathilake C. Primary hyperparathyroidism in an adolescent presenting with genu valgus progressing to extensive bone disease; a case report. BMC Endocr Disord 2023; 23:71. [PMID: 37004024 PMCID: PMC10064545 DOI: 10.1186/s12902-023-01328-z] [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: 12/19/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Primary hyperparathyroidism which is rare in adolescents presents commonly with non-specific symptoms and systemic complaints. Though there are few reported cases of genu valgus, genu valgus progressing to extensive bone disease despite mildly elevated calcium had not been reported before. CASE PRESENTATION A 12-year-old male had been evaluated for bilateral (left > right) genu valgus and short stature. Serum calcium and phosphate levels had been normal. X-ray of the femora and pelvic bones had not shown additional abnormalities. Valgus deformity progressed despite left femoral plating, and a left distal femoral medial closed wedge osteotomy had been performed at 15 years. Plain imaging at that time had shown localised osteopaenia. At the age of 17 years, he developed multiple fragility fractures of his left hip rendering him wheelchair-bound. Further evaluation revealed a serum PTH level of 2571 (10-65) pg/mL with calcium of 2.82 (2.2-2.6) mmol/L and inorganic phosphate of 1.7 (2.2-4.7) mg/dL. The lumbar spine DXA scan showed a Z-score of -5.8. A left parathyroid adenoma was localised and there was evidence of hyperparathyroid bone disease including brown tumours. He underwent left parathyroidectomy and left thyroid lobectomy after which his PTH level dropped to 4.03 pg/mL. He developed hypocalcaemia which was managed successfully with calcium and alfacalcidol replacement. CONCLUSIONS Primary hyperparathyroidism can present with genu valgus in adolescents. Initial normocalcaemia which could be due to concomitant vitamin D deficiency could mask this leading to delayed diagnosis until severe irreversible bone disease ensues.
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Affiliation(s)
- Nipun Lakshitha de Silva
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Boralesgamuwa, Sri Lanka
| | - Mihiran Denagama Jayalath
- Medical Unit, University Hospital-General Sir John Kotelawala Defence University, Boralesgamuwa, Sri Lanka
| | - W. K. Chaminda Sampath
- Department of Radiology, University Hospital-General Sir John Kotelawala Defence University, Boralesgamuwa, Sri Lanka
| | - Ranga Perera
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Boralesgamuwa, Sri Lanka
| | - Chandana Karunathilake
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Boralesgamuwa, Sri Lanka
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Revisiting Captain Charles Martell: witnessing the true face of primary hyperparathyroidism even in the twenty-first century. Arch Osteoporos 2022; 17:148. [PMID: 36418608 DOI: 10.1007/s11657-022-01187-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe presentation of primary hyperparathyroidism (PHPT) which, although, common in the Asian population, is albeit rarely encountered in the present era. CASE PRESENTATION We present a 23-year-old lady whose symptoms began in 2016 with generalized body aches. Subsequently, her husband noticed a reduction in her height and she developed gradual protrusion of chest. Meanwhile, she conceived in November 2019 and delivered a full-term healthy baby girl. She breastfed her baby for 18 months during which her symptoms worsened. On examination, she measured only 123 cm, having lost nearly 23 cm in height. She had a short neck, pectus carinatum-like deformity of chest, protruded abdomen, kyphosis, and scoliosis. Investigations revealed PTH-dependent hypercalcemia, diffuse cortical thinning, brown tumors, codfish vertebrae, and bilateral nephrolithiasis. A diagnosis of primary hyperparathyroidism (PHPT) was made with the grave clinical picture bearing a striking resemblance to that of Captain Charles Martell, the first ever recorded case of PHPT in the world. CONCLUSION The index case highlights the fact that PHPT, if left undiagnosed and untreated, can have debilitating consequences. A high index of suspicion should be exercised while evaluating all suspected cases of metabolic bone disorders and being the third most common endocrine disorder, the possibility of PHPT should be entertained wherever appropriate.
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A 14-year-old boy with urolithiasis and hypercalcemia: Answers. Pediatr Nephrol 2022; 37:2629-2633. [PMID: 35445977 DOI: 10.1007/s00467-022-05562-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
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Soldati E, Rossi F, Vicente J, Guenoun D, Pithioux M, Iotti S, Malucelli E, Bendahan D. Survey of MRI Usefulness for the Clinical Assessment of Bone Microstructure. Int J Mol Sci 2021; 22:2509. [PMID: 33801539 PMCID: PMC7958958 DOI: 10.3390/ijms22052509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
Bone microarchitecture has been shown to provide useful information regarding the evaluation of skeleton quality with an added value to areal bone mineral density, which can be used for the diagnosis of several bone diseases. Bone mineral density estimated from dual-energy X-ray absorptiometry (DXA) has shown to be a limited tool to identify patients' risk stratification and therapy delivery. Magnetic resonance imaging (MRI) has been proposed as another technique to assess bone quality and fracture risk by evaluating the bone structure and microarchitecture. To date, MRI is the only completely non-invasive and non-ionizing imaging modality that can assess both cortical and trabecular bone in vivo. In this review article, we reported a survey regarding the clinically relevant information MRI could provide for the assessment of the inner trabecular morphology of different bone segments. The last section will be devoted to the upcoming MRI applications (MR spectroscopy and chemical shift encoding MRI, solid state MRI and quantitative susceptibility mapping), which could provide additional biomarkers for the assessment of bone microarchitecture.
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Affiliation(s)
- Enrico Soldati
- CRMBM, CNRS, Aix Marseille University, 13385 Marseille, France;
- IUSTI, CNRS, Aix Marseille University, 13013 Marseille, France;
- ISM, CNRS, Aix Marseille University, 13288 Marseille, France; (D.G.); (M.P.)
| | - Francesca Rossi
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (F.R.); (S.I.); (E.M.)
| | - Jerome Vicente
- IUSTI, CNRS, Aix Marseille University, 13013 Marseille, France;
| | - Daphne Guenoun
- ISM, CNRS, Aix Marseille University, 13288 Marseille, France; (D.G.); (M.P.)
- Department of Radiology, Institute for Locomotion, Saint-Marguerite Hospital, ISM, CNRS, APHM, Aix Marseille University, 13274 Marseille, France
| | - Martine Pithioux
- ISM, CNRS, Aix Marseille University, 13288 Marseille, France; (D.G.); (M.P.)
- Department of Orthopedics and Traumatology, Institute for Locomotion, Saint-Marguerite Hospital, ISM, CNRS, APHM, Aix Marseille University, 13274 Marseille, France
| | - Stefano Iotti
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (F.R.); (S.I.); (E.M.)
- National Institute of Biostructures and Biosystems, 00136 Rome, Italy
| | - Emil Malucelli
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy; (F.R.); (S.I.); (E.M.)
| | - David Bendahan
- CRMBM, CNRS, Aix Marseille University, 13385 Marseille, France;
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Pediatric Primary Hyperparathyroidism: Experience in a Tertiary Care Referral Center in a Developing Country Over Three Decades. World J Surg 2020; 45:488-495. [PMID: 33047232 DOI: 10.1007/s00268-020-05816-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is limited experience in managing pediatric primary hyperparathyroidism (PHPT). The aim of this study was to analyze the clinical presentation and outcome of surgery in children with PHPT managed at a tertiary referral center. METHODS This retrospective study (September 1989-August 2019) consisted of 35 pediatric PHPT patients (< 18 years) who underwent parathyroidectomy. Clinico-pathologic profile and outcome were noted. RESULTS The mean age of cohort was 15.2±2.9 years and girls outnumbered boys (M:F = 1:1.9). Familial and symptomatic disease was noted in 8.5 and 94.3% cases, respectively. Skeletal manifestations (83%) were the commonest followed by renal (29%). Fifty-four percent children had skeletal fractures, and 23% were bed-ridden. Among rare manifestations, hypercalcemic crisis, recurrent pancreatitis and stigmata of rickets were observed in 2.8, 11.4 and 14.2% children, respectively. Mean calcium concentration was 12.1 ± 2.0 mg/dl and PTH 91.8 ± 66.5 pmol/L. The sensitivity of preoperative imaging in parathyroid localization was 91.4%. Minimally invasive parathyroidectomy (MIP) was performed in 40% cases. Parathyroid adenoma was observed in 91.4% patients, whereas remaining had hyperplasia. Thirty-four percent suffered from Hungry bone syndrome in postoperative period. The cure rate following primary surgery was 97%. One child with persistent PHPT had successful re-operation. Median follow-up was 5 (1-17) years, and no recurrence or familial disease was revealed during this period. CONCLUSION Majority of pediatric patients present with symptomatic PHPT. Despite relatively high incidence of familial disease select pediatric patients can undergo successful MIP.
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Pradhan R, Agarwal A, Gupta SK. PHPT Masquerading as Rickets in Children and Presenting with Rare Skeletal Manifestations: Report of Three Cases and Review of Literature. Indian J Endocrinol Metab 2018; 22:705-709. [PMID: 30294584 PMCID: PMC6166568 DOI: 10.4103/ijem.ijem_54_18] [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] [Indexed: 11/05/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) is an uncommon condition in children and adolescents. However, rapid growth spurt during puberty may result in unmasking and development of certain skeletal manifestations of PHPT. We present three cases of PHPT associated with rare skeletal manifestations of rickets. All three patients had radiological evidence of rickets with primary hyperparathyroidism. All the three patients had single gland adenoma. Literature is sparse regarding reversal of features of rickets following parathyroidectomy. In all three patients of our series, there was a complete resolution of bone/joint pain. However, in two children only the genu valgum persisted but their growth was normal and they had no proximal muscle weakness. In another child multiple corrective surgeries were done to correct the deformities.
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Affiliation(s)
- Roma Pradhan
- Department of Endocrine Surgery, Dr RMLIMS, Lucknow, Uttar Pradesh, India
| | - Amit Agarwal
- Department of Endocrinology, SGPGIMS, Lucknow, Uttar Pradesh, India
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Wang W, Kong J, Nie M, Jiang Y, Li M, Xia W, Meng X, Xing X, Wang O. Primary hyperparathyroidism in Chinese children and adolescents: A single-centre experience at Peking Union Medical College Hospital. Clin Endocrinol (Oxf) 2017; 87:865-873. [PMID: 28833384 DOI: 10.1111/cen.13453] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/06/2017] [Accepted: 08/16/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) in children is thought to be extremely rare. Our study aimed to summarize the clinical characteristics and the molecular genetics in patients with paediatric PHPT in China. DESIGN Retrospective observational study. METHODS A total of 59 paediatric PHPT patients (onset age <18 years) admitted to Peking Union Medical College Hospital from 1975 to 2015 were retrospectively identified. A group of 118 adult PHPT patients who presented during the same period were selected for comparing clinical characteristics between the two groups. Germline mutation analyses of the MEN1, CDC73, RET, CDKN1B and CaSR genes were performed in 24 patients. RESULTS Only one paediatric patient (1.7%) with PHPT was asymptomatic. Bone involvement, urolithiasis, acute pancreatitis and hypercalcaemic crisis were present in 86.4%, 39.0%, 6.8% and 10.2% of cases, respectively. Paediatric PHPT presented more commonly with rickets/osteomalacia compared to adult PHPT. Fifty-seven paediatric patients underwent surgery. Adenoma, hyperplasia, atypical adenoma and carcinoma occurred in 80.7%, 10.5%, 7.0% and 1.8% of cases, respectively. Of the 24 paediatric patients screened for genetic mutations, two patients were found to carry MEN1 mutations and six were found to carry CDC73 mutations. The mutation rate was 22.2% (4/18) in sporadic patients. CONCLUSION Unlike adults with PHPT, most paediatric PHPT were symptomatic. Rickets/osteomalacia was more common in paediatric patients than in their adult counterparts. Paediatric PHPT patients can be treated successfully with surgical intervention. Genetic screening of the MEN1 and CDC73 genes for mutations should be recommended in paediatric patients due to a relatively high mutation rate.
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Affiliation(s)
- Wenbo Wang
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Kong
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Min Nie
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Jiang
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Li
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Weibo Xia
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xunwu Meng
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoping Xing
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ou Wang
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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