title: Outcomes of minimally invasive parathyroidectomy in pediatric patients with primary hyperparathyroidism owing to parathyroid adenoma: A single institution experience.
abstract: BACKGROUND
  Guidelines for treatment of primary hyperparathyroidism (PHPT) in young patients recommend surgery. Outcomes of minimally invasive parathyroidectomy (MIP) are well established in adults, but not in pediatric patients.
  
  
  OBJECTIVE
  The objective of the study is to determine effectiveness of preoperative imaging and MIP aided by intraoperative PTH (ioPTH) measurement in children with primary hyperparathyroidism (PHPT).
  
  
  METHODS
  This is a retrospective chart review of diagnostic and follow-up data up to 12months post-MIP of patients with PHPT who underwent parathyroidectomy at the Children's Hospital of Philadelphia between January 1, 2009 and March 31, 2015.
  
  
  RESULTS
  Data were available for 16 of 17 patients age 8-17years (11 females, 6 males): 2 had ectopic intrathymic adenomas while 14 had eutopic adenomas. Fifteen patients had ioPTH, including 14 who underwent MIP, defined as a 2cm central neck incision. All patients with data at 6months postparathyroidectomy (13/16) showed normal PTH and calcium. Ultrasound and sestamibi scans had a combined sensitivity of 87.5%.
  
  
  CONCLUSIONS
  MIP is an appropriate alternative to standard neck exploration in pediatric patients with PHPT with a single parathyroid adenoma. ioPTH is especially useful to confirm cure and limit surgical exploration when imaging studies are negative. Sestamibi scans and ultrasound are complementary studies.
authors.affiliation: Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, and the University of Pennsylvania Perelman School of Medicine.
authors.forename: Edna E
authors.initials: EE
authors.lastname: Mancilla
authors.affiliation: Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, and the University of Pennsylvania Perelman School of Medicine. Electronic address: levinem@chop.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Levine
authors.affiliation: Department of Surgery, The Children's Hospital of Philadelphia, and the University of Pennsylvania Perelman School of Medicine.
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Hypercalcemia; Hyperparathyroidism; Intraoperative PTH; Minimally invasive parathyroidectomy