Pediatric Hyperparathyroidism Diagnosis and Treatment

Primary hyperparathyroidism in young patients is a rare endocrine disorder characterised by excessive secretion of parathyroid hormone from one or more glands. Affected children often present with non-specific symptoms, including polyuria, fatigue, abdominal pain, bone pain or musculoskeletal deformities such as genu valgum. Biochemical evaluation reveals hypercalcaemia, hypophosphataemia and elevated parathyroid hormone levels, prompting further imaging for gland localisation. Ultrasonography and technetium-based nuclear scans remain first-line modalities, with advanced cross-sectional techniques reserved for ectopic adenomas. Genetic screening for syndromic forms, notably MEN1, informs both surgical planning and family counselling. The cornerstone of definitive management is surgical excision of the pathological gland(s), performed via minimally invasive or bilateral neck exploration techniques. Attention to perioperative calcium dynamics, including intraoperative hormone monitoring and postoperative hungry bone syndrome prophylaxis, is critical to optimise outcomes and reduce recurrence. Early recognition and a multidisciplinary approach underpin global efforts to mitigate irreversible skeletal and renal complications in paediatric cohorts.

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Pediatric Hyperparathyroidism Diagnosis and Treatment publication trend

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Technical terms

Primary hyperparathyroidism: Overproduction of parathyroid hormone by one or more parathyroid glands, leading to deranged calcium and phosphate metabolism.

Parathyroid hormone (PTH): A peptide hormone that regulates blood calcium and phosphate levels through actions on bone, kidney and intestine.

Adenoma: A benign neoplasm of the parathyroid gland responsible for the majority of sporadic hyperparathyroidism cases.

99mTc-sestamibi scan: A nuclear imaging technique used to localise hyperfunctioning parathyroid tissue based on radiotracer uptake.

Intraoperative PTH monitoring: Measurement of parathyroid hormone levels during surgery to confirm removal of hypersecreting tissue.

Hungry bone syndrome: Rapid uptake of calcium by bone after parathyroidectomy, resulting in transient postoperative hypocalcaemia.

Cinacalcet: An oral calcimimetic agent that lowers parathyroid hormone levels by enhancing calcium-sensing receptor sensitivity.

References

1. Pediatric Neuroendocrine Neoplasia of the Parathyroid Glands: Delving into Primary Hyperparathyroidism. Biomedicines (2023).
2. Identifying an Ectopic Parathyroid Adenoma Using 4DCT in a Pediatric Patient with Persistent Primary Hyperparathyroidism. Case Reports in Otolaryngology (2013).
3. Intraoperative Parathyroid Hormone Monitoring Corroborates the Success of Parathyroidectomy in Children. Journal of Clinical Research in Pediatric Endocrinology (2014).
4. Minimally Invasive Parathyroidectomy in a Child With Acute Pancreatitis. Cureus (2022).
5. Primary Hyperparathyroidism as a Rare Cause of Unexplained Recurrent Abdominal Pain: Case Presentation and Literature Review. Cureus (2021).
6. Primary hyperparathyroidism in an adolescent presenting with genu valgus progressing to extensive bone disease; a case report. BMC Endocrine Disorders (2023).