ESPE Abstracts (2014) 82 P-D-3-1-672

Obese Adolescent with Gait and Depression

Vera Zdravkovica,b, Vladan Zivaljevicb,c, Vadislav Bojica, Maja Jesica,b, Natasa Dragutinovica & Silvija Sajica,b


aUniversity Children Hospital, Belgrade, Serbia; bFaculty of Medicine, University of Belgrade, Belgrade, Serbia; cCentre for Endocrine Surgery, Clinical Centre of Serbia, Belgrade, Serbia


Introduction: Hypercalcaemia is an uncommon electrolyte disorder, frequently discovered incidentally based on routine blood chemistry results.

Case report: A 14-year-old adolescent was admitted to the Endocrinology Department due to obesity, gait and depression. His weight had been gradually increasing over the previous 2 years, and on admission his BMI was 31.5 kg/m2. The pain in his legs started a year ago, but worsened progressively and in the months prior to admission, the patient could not walk without the aid of crutches. He was on antidepressant therapy due to adjustment disorder. oGTT showed impaired glucose tolerance, but incidental finding was hypercalcemia. A detailed family history ruled out the possibility of various forms of familial hyperparathyroidism and since a neck ultrasound did not show any abnormalities, Technetium-99m sestamibi scintigraphy was performed, which demonstrated a right-sided parathyroid adenoma. Minimally invasive parathyroidectomy was performed successfully with a decrease in PTH levels (from 640.7 to 6.55 pg/ml). Seven days after surgery, biochemical test results indicated hungry bone syndrome (serum calcium level 1.9 mmol/l, serum phosphate level 1.0 mmol/l). After 4 weeks calcium supplementation therapy and antidepressants were stopped. One year after surgery, he walks normally, no signs of depression and calcium levels are normal. The remaining problem is his struggle to loose weight, his BMI is 34.8.

Table 1.
BiochemistryNormal values
Calcium (mmol/l)3.54↑2.02–2.60
Phosphate (mmol/l)0.921.0–2.0
Alkaline phosphatase (U/l)982 ↑<618
Ca/Cr urine0.17<0.01
iPTH (pg/ml)503.1↑10–60

Conclusion: Hyperparathyroidism is rare in children, but we have to consider measurement of calcium in a child with pain in legs and mood changes.

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