ESPE Abstracts

Introduction: Hyperparathyroidism is a disorder usually seen in adults and rarely in childhood.

Case: A 14 years and 7 months old girl complaining of constipation applied to pediatric gastroenterology department was consultant to pediatric endocrinology department due to increased plasma calcium levels. She was healthy previously and had no vitamin D usage. In her physical exam; body weight: 53.8kg (-0.12 SD), height: 153,5cm (-1.32 SD), BMI: 22.83kg/m²(0.74 SD), blood pressure: 90/60mmHg and puberty was Tanner Stage-5. Other systemic exams were normal. In laboratory detection; plasma calcium: 12.7mg/dL(8.8-10.6), phosphorus: 3.0mg/dL(4.5-5.5), PTH: 306pg/ml(15-68), alkalen phosphotase: 168U/L(30-500), spot urine Ca/creatinin: 0.21 and 25-hydroksivitamin-D: 4.9ng/ml(N>20). Hemogram, venous blood gase detection, plasma free thyroxin, Tyrotropin releasing hormone, BUN, creatinin, albümin and magnesium levels and QTc time in electrocardiogram were normal. Via these data she was diagnosed as primary hyperparathyroidism and initial intravenous hidration and furosemid treatment started. Plasma calcium levels did not decrease after initial treatment and she had pamidronat infusion with the dose of 0,8mg/kg/day, twice and plasma calcium levels decreased to normal levels in 48 hours time. X-Ray detections of hand-ankle and head, urinary ultrasonography was normal. Thyroid USG revealed an image next to posterior-inferior right thyroid lobe, with dimensions of 12x4.5 mm, smooth borders and central hyperechogen identation which suggests a parathyroid adenoma. Teknesyum-99m sestamibi (99mTc MIBI) scintigraphy revealed an extra thyroid, partially hypoechoic lesion in right thyroid inferior region next to posterior thyriod capsule with dimensions of 10x8x10 mm. The patient was operated with the diagnosis of parathyroid adenoma. Postoperative plasma Ca was 11 mg/dL, and PTH: 378 pg/ml. Pathological examination was normal parathyroid tissue and she underwent second surgery. After reoperation plasma Ca was 9.6 mg/dL, and PTH: 25 pg/ml. Pathological examination was concordant with parathyroid adenoma.

Conclusion: Although is very rare in childhood, parathyroid adenoma should be keep in mind in patients with hypercalcemia and no history of vitamin D usage. Early diagnose and treatment is important because late diagnosis may result irreversbl target organ damages.