title: Primary hyperparathyroidism in pediatric patients.
abstract: OBJECTIVE
  Primary hyperparathyroidism (HPT) is unusual in children. We reviewed our experience with HPT to better characterize these children.
  
  
  METHODS
  The retrospective review of patients <19 years old who underwent parathyroid resection for primary HPT from 1970 to 2000 was performed at a single institution..
  
  
  RESULTS
  Fifty-two patients were identified. Median age was 16.8 years (range: 4-18.9) with a female-to-male ratio of 3:2. Eighty-five percent had an elevated parathyroid hormone (PTH) level, and 15% had an inappropriately normal PTH level during hypercalcemia. Serum calcium was elevated in all patients except for 2 with multiple endocrine neoplasma (MEN)-IIA and 1 with familial non-MEN HPT, but both had elevated PTH levels. Alkaline phosphatase levels were significantly higher in children with documented bone involvement. At presentation 41 patients (79%) were symptomatic and end-organ damage (nephrocalcinosis, nephrolithiasis, acute pancreatitis, or bone involvement) occurred in 23 patients (44%). Thirty-four patients (65%) had a single adenoma; hyperplasia was identified in 16 patients (27%), and of these cases, 57% occurred in patients diagnosed with MEN-I. Short-term complications included transient hypocalcemia in 29 patients (56%) and transient vocal cord paralysis in 2 patients (4%). Long-term complications were significant for permanent hypocalcemia in 2 patients (4%) and no recurrent laryngeal nerve injuries. No parathyroid abnormalities were identified during exploration in 4 (8%) children. Long-term follow-up was achieved in 98% of patients for a mean and median of 13 years. Resolution of hypercalcemia was achieved in 94% of cases.
  
  
  CONCLUSIONS
  The diagnosis of primary HPT in pediatric patients is frequently delayed, is commonly symptomatic, and has significant morbidity. For children in whom HPT is suspected, evaluation of serum calcium and PTH levels is diagnostic in 100% of children. Parathyroid resection is effective at restoring normal serum calcium, has few complications, and is the treatment of choice for children with primary hyperparathyroidism.
authors.affiliation: Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
authors.forename: Josh
authors.initials: J
authors.lastname: Kollars
authors.forename: Abdalla E
authors.initials: AE
authors.lastname: Zarroug
authors.forename: Jon
authors.initials: J
authors.lastname: van Heerden
authors.forename: Aida
authors.initials: A
authors.lastname: Lteif
authors.forename: Penny
authors.initials: P
authors.lastname: Stavlo
authors.forename: Luis
authors.initials: L
authors.lastname: Suarez
authors.forename: Christopher
authors.initials: C
authors.lastname: Moir
authors.forename: Michael
authors.initials: M
authors.lastname: Ishitani
authors.forename: David
authors.initials: D
authors.lastname: Rodeberg
mesh_terms: D000236:Adenoma / Q000150:complications; D000293:Adolescent; D001851:Bone Diseases, Metabolic / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D006961:Hyperparathyroidism / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D006996:Hypocalcemia / Q000209:etiology; D007669:Kidney Calculi / Q000209:etiology; D008297:Male; D009377:Multiple Endocrine Neoplasia / Q000150:complications; D009397:Nephrocalcinosis / Q000209:etiology; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications; D016105:Parathyroidectomy; D011183:Postoperative Complications; D012189:Retrospective Studies; D017678:Sex Distribution
chemical_list: D010281:Parathyroid Hormone