Introduction: Parathyroid adenoma (PRAD) is less common than in adulthood, but its morbidity is higher in children. The typical presentation is incidentally discovered as asymptomatic hypercalcemia. We aimed to evaluate the clinical characteristics of PRAD and our clinical experience since the early disease is often asymptomatic.
Method: From 2010-2020, all children diagnosed with PRAD at our institution were reviewed. We evaluated clinical, biochemical, radiological aspects, and follow-up characteristics.
Results: There were eight subjects (F/M=6/2) ranging in age from 10 to 17 years. Two were prepubertal. Only three were symptomatic. The symptoms were stomachache (n = 3), myalgia (n = 2), weakness (n = 2), pancreatitis (n = 1), constipation (n = 1), nausea (n = 1), anorexia (n = 1). One had a family history of MEN-1 syndrome, and two were sisters with a family history of PRAD.
Laboratory findings on admission were as followings: the mean calcium (Ca) 12.59 ± 1.28 [11.2 - 15.3] mg/dl, the mean phosphorus (P) 3.57 ± 0.87 [2-4.6]mg/dl, the mean alkaline phosphatase (ALP) 222.38 ± 116.51 [83-399]IU/L, and the mean parathyroid hormone (PTH) 244.81 ± 173.61 [74.9-645.4]pg/ml (n = 8). All subjects underwent neck ultrasonography (US), and long diameters of PRADs (n = 7) were measured as 11 to19mm. PRAD could not be demonstrated by the US in one patient. Tc-99m-Sestamibi scintigraphy revealed the presence of PRAD in only six. Arrhythmia, nephrolithiasis, and bone resorption were not observed in any of the subjects. They underwent parathyroidectomy. One subject was on pamidronate, and one other subject was on alendronate before surgery. The mean Ca decreased to 8.78 ± 0.59mg/dl [8.2 -9.2], and the mean PTH decreased to 56.9 ± 71.86 [7.7-195.9]pg/ml at the first postoperative day. After a year of surgery, physical examinations of all were normal, laboratory findings were as followings: the mean Ca 9,71 ± 0,27 [9.4-10.2]mg/dl, the mean P 4,63 ± 0,73[3.84-5.94]mg/dl, PTH 44.55 ± 8.38 [33.5-76.4]pg/ml. In our follow-up, two subjects needed reoperation. Molecular analysis of six subjects could be done. Only one of three subjects with a family history had MEN1 positive. RET sequence analysis of two, and Casr, GNA11, AP2S1 sequence analysis of three were normal.
Conclusion: PRAD should be considered in children older than 10 years of age with hypercalcemia. It should be kept in mind that most of the cases are asymptomatic at diagnosis. Suspected cases should undergo both US and scintigraphy to detect PRAD. Patients should be carefully followed up for risk of familial HPT.
22 Sep 2021 - 26 Sep 2021