An 11-year-old boy came to our hospital on 2019-1-23 because of "discovered hypercalcemia for 4 months."
Past History: The child has a history of lupus nephritis for 2 years, and currently oral prednisone 12.5mg qd, mycophenolic acid 0.25g q12h, tacrolimus 1mg q12h for treatment. The lupus activity index was reviewed once a month due to lupus nephritis. At present, SLEDAI (lupus activity score) is 2 points, and the condition is well controlled.
Four months ago, serum calcium was found to increase by 2.83 mmol/L, without any complaint, vitamin D and calcium were discontinued. Serum calcium gradually increased in the past four months.
Physical Examination: no bone developmental deformity, no bone pain and tenderness, no abnormal findings in the physical examination.
Lab Testing: the serum calcium was 3.0 mmol/L, serum phosphorus was 1.16mmol/L, serum magnesium 0.64mmol/L, intact PTH 107.50pg/mL, ALP 224U/L, vitamin D 11ng/ml, 24-hour urine calcium 2.2mmol/L (0.046mmol/kg.d). Thyroid function and adrenal function are normal. Color Doppler ultrasound about thyroid, kidney, adrenal gland, testis, and pancreas were normal. There was no abnormality in the chest radiograph. Parathyroid gland color doppler ultrasound showed: hypoechoic nodules on the dorsal side of the left thyroid gland, considering hyperplastic parathyroid glands. 99mTc-MIBI parathyroid imaging showed: Parathyroid imaging (rear behind the left lobe) is positive.
Therefore, the clinical diagnosis is parathyroid adenoma, lupus nephritis. Unfortunately, there is no genetic testing result and no pathological findings of the parathyroid glands because parents do not agree with the test and surgery.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology