Hyperparathyroidism after irradiation for childhood malignancy.
OBJECTIVE
To examine the occurrence of hyperparathyroidism in a cohort of patients undergoing combined parathyroid and thyroid surgery after previous head-and-neck irradiation for childhood malignancy.


METHODS
This is a retrospective cohort study for the years 1996 to 2007. The study group comprised patients undergoing surgery in the University of Sydney Endocrine Surgical Unit who had received previous head-and-neck irradiation in childhood and who were identified as having pathologic thyroid and parathyroid characteristics.


RESULTS
A total of 53 patients were identified in whom head-and-neck irradiation for the treatment of childhood malignancy had been documented. In each of the cases, thyroid disease was the primary reason for referral for surgery. Five of these patients (10%) were found to exhibit coexisting hyperparathyroidism. The latency period for hyperparathyroidism was less than 20 years in 4 of the 5 cases. There were four conventional parathyroid adenomas and one parathyroid lipoadenoma. All patients exhibited a significant decrease in postoperative calcium levels after surgery.


CONCLUSIONS
To our knowledge, this is the first study to document the significant risk of hyperparathyroidism after radiation exposure for childhood malignancy. The timeframe for development of disease is much shorter than that published for individuals who have undergone irradiation for benign diseases. High doses of therapeutic radiation at a young age make childhood survivors of malignancy at especially high risk for developing hyperparathyroidism.
McMullen
Todd
T
University of Sydney Endocrine Surgical Unit, Sydney, NSW, Australia.
Bodie
Greg
G
Gill
Anthony
A
Ihre-Lundgren
Catharina
C
Shun
Albert
A
Bergin
Mary
M
Stevens
Graham
G
Delbridge
Leigh
L
D000293:Adolescent; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D006961:Hyperparathyroidism / Q000453:epidemiology* / Q000601:surgery; D007223:Infant; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D017741:Survivors; D013964:Thyroid Neoplasms / Q000453:epidemiology* / Q000601:surgery; D014916:Whole-Body Irradiation / Q000009:adverse effects; D055815:Young Adult