title: Focused image-guided parathyroidectomy in the current management of primary hyperparathyroidism.
abstract: OBJECTIVE
  Primary hyperparathyroidism (PHPT) in childhood and adolescence has been considered a different disease to that seen in adults, with predominantly familial aetiology mandating open exploration to exclude parathyroid hyperplasia in contrast to the adoption of focused image-guided parathyroidectomy (FP) in adults.
  
  
  METHODS
  A retrospective cohort study in a tertiary referral hospital setting of all children and adolescents (<18 years) undergoing parathyroid surgery for PHPT. Data were obtained from a dedicated endocrine surgery database and hospital medical records.
  
  
  RESULTS
  Over the 35-year study period (1980-2014), there were 31 patients who underwent parathyroidectomy for PHPT. 3 patients were from known multiple endocrine neoplasia type 1 syndrome (MEN1) families, 3 had an isolated family history of PHPT and 25 were sporadic. In the sporadic group, 24 (96%) presented with symptomatic hypercalcaemia, affecting the gastrointestinal, musculoskeletal, genitourinary or neuropsychiatric systems. In the 25 patients with sporadic PHPT, nine (36%) had FP with a single adenoma removed with a 100% initial cure rate. Sixteen patients (64%) in the sporadic group had an open exploration: 14 had single gland disease while 2 patients required a second procedure to achieve a final cure rate of 100%. Of the three patients with MEN1, one was cured, one has persistent hyperparathyroidism after FP and the third has permanent hypoparathyroidism after open exploration.
  
  
  CONCLUSIONS
  The majority of children and adolescents with PHPT have symptomatic disease due to a single adenoma. They can therefore be managed in a similar fashion to their adult counterparts with preoperative localisation studies aiming to permit FP in a day case setting.
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Langusch
authors.affiliation: University of Sydney Endocrine Surgical Unit, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Olov
authors.initials: O
authors.lastname: Norlen
authors.affiliation: Department of Endocrinology, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Titmuss
authors.affiliation: Department of Endocrinology, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Donoghue
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Andrew J A
authors.initials: AJ
authors.lastname: Holland
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Albert
authors.initials: A
authors.lastname: Shun
authors.affiliation: University of Sydney Endocrine Surgical Unit, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Leigh
authors.initials: L
authors.lastname: Delbridge
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D008297:Male; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted
keywords: Endocrinology; Paediatric Surgery; Procedures