title: Primary hyperparathyroidism in a paediatric hospital.
abstract: We retrospectively reviewed the presentation and management of children with primary hyperparathyroidism (PHPT) from 1973 to 1995 at a paediatric tertiary-care centre. There were 11 patients (6 females), aged 12.3-17.7 years at presentation, with sporadic PHPT confirmed by histopathology (single adenoma). Presentation consisted of renal colic, or non-specific gastrointestinal, musculoskeletal or neurological symptoms. Misdiagnosis was common until hypercalcaemia was identified, 0.5-24 months after onset of symptoms (mean 7.7 months). All patients had hypercalcaemia and low-normal serum phosphate. The parathyroid hormone (PTH) radioimmunoassay used before 1986 was elevated in 1/4 patients; the intact PTH assay used after 1986 was elevated in 7/7 patients. At presentation, six had end-organ damage: band keratopathy, renal lesions, and/or bone disease. Preoperative localization was accurate in 0/4 patients diagnosed before 1986, but 5/7 patients diagnosed after 1986: three by ultrasound or sestamibi scan alone, and two by ultrasound and technetium scan. Surgical outcome was not dependent upon the accuracy of pre-operative localization. PHPT is rare in children but usually associated with end-organ damage, presumably due to delayed diagnosis. It should be considered in the differential diagnosis of unexplained non-specific complaints. The intact PTH assay greatly assists pre-operative diagnosis. The usefulness of pre-operative localization requires further research.
authors.affiliation: Department of Pediatrics, University of Toronto, Canada.
authors.forename: M L
authors.initials: ML
authors.lastname: Lawson
authors.forename: S F
authors.initials: SF
authors.lastname: Miller
authors.forename: G
authors.initials: G
authors.lastname: Ellis
authors.forename: R M
authors.initials: RM
authors.lastname: Filler
authors.forename: S W
authors.initials: SW
authors.lastname: Kooh
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D006961:Hyperparathyroidism / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006973:Hypertension / Q000209:etiology; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D012189:Retrospective Studies; D014839:Vomiting / Q000209:etiology
chemical_list: D010281:Parathyroid Hormone