![]() ![]() The 25-OH-vitamin D level increased from 6.09 ng/mL to 20.05 ng/mL. The iPTH level increased from 36.5 pg/mL (immediately postoperatively) to 117.0 pg/mL. His ALP level had slightly decreased from > 2,300 IU/L to 2,193 IU/L. He showed normalized levels of calcium (8.9 mg/dL) and phosphate (3.6 mg/dL). He was followed up on postoperative day 12 at an outpatient clinic. The patient showed no signs or symptoms of hypocalcemia, so he was discharged on postoperative day 1 with a prescription for an oral agent containing elemental calcium 26.4 mg/kg/day and cholecalciferol 2,400 IU/day. On postoperative day 1, serum calcium level increased from 7.7 mg/dL to 8.1 mg/dL. The oral calcidiol given before surgery was discontinued in favor of another calcium carbonate-calcidiol combination oral agent to provide more calcium and calcidiol after surgery. To rule out genetic forms of PHPT, next-generation sequencing was performed using the Illumina Nextseq550 Sequence System (Illumina, Inc., San Diego, CA, USA), which showed no significant results corresponding with the clinical findings of MEN1, RET, HRPT2, or CASR.Īfter surgery, serum calcium dropped sharply from 12.8 mg/dL to 7.7 mg/dL. Fractional excretion of calcium was 1.3%, which favors diagnosis of PHPT rather than FHH. A 24-hour urinalysis revealed values suggestive of hypercalciuria (a urine-Ca-to-Cr ratio of 0.45 ). Laboratory evaluation showed hypercalcemia (12.8 mg/dL reference range, 8.5–10.5 mg/dL), hypophosphatemia (2.0 mg/dL reference range, 3.8–5.9 mg/dL), ALP > 2,300 IU/L (reference range, 81–316 IU/L), elevated intact PTH (iPTH, 1,930 pg/mL reference range, 15–65 pg/mL), vitamin D deficiency (25-OH-vitamin D level of 6.09 ng/mL reference range, 30–100 ng/mL), and elevated 1a-25(OH)-vitamin D level (115.9 pg/mL reference range, 19.6–54.3 pg/mL), which suggested PHPT rather than secondary or tertiary hyperparathyroidism. After curative parathyroid resection, the prognosis is usually favorable without complications. In all pediatric PHPT patients, surgical resection of the parathyroid gland is required for definitive treatment. In a previous study, the authors reported that ectopic parathyroid adenoma accounts for 6%–16% of total parathyroid adenomas, and the most common ectopic location is the thymus, which accounts for 38% of ectopic parathyroid adenomas. PHPT is caused by a solitary parathyroid adenoma in 80% of diagnosed adults and 65%–70% of children. Pediatric PHPT may occur due to genetic causes, such as familial hypocalciuric hypercalcemia (FHH), familial isolated hyperparathyroidism, and multiple endocrine neoplasia (MEN). In contrast, PHPT cases are rare in children and are likely to account for <5% of the cases of hypercalcemia in children. Parathyroid carcinoma occurs rarely, accounting for <1% of all cases of PHPT. Primary hyperparathyroidism (PHPT) accounts for > 90% of hypercalcemia in adults, and most patients with PHPT present with a single adenoma (80%) or hyperplasia (15%–20%) of the parathyroid gland. The causes of hypercalcemia in children can be classified as parathyroid hormone (PTH)-dependent or PTH-independent and may be either congenital or acquired. Hypercalcemia is uncommon in children patients typically present with characteristic signs/symptoms or may be diagnosed incidentally following investigations for a variety of nonspecific conditions. Keywords: Primary hyperparathyroidism, Hypercalcemia, Ectopic parathyroid gland, Parathyroid adenoma, Child If ectopic parathyroid adenomas are well localized in preoperative imaging evaluation and intraoperative iPTH level decreases after resection, ectopic parathyroidectomy without bilateral neck exploration may be performed to avoid unnecessary morbidity. Delayed diagnosis of PHPT can cause end-organ damage a timely diagnosis is especially critical to preserve bone and renal function. Intact parathyroid hormone (iPTH) and alkaline phosphatase levels returned to normal ranges within 3 months. After surgery, the patient’s serum calcium level immediately normalized. Pathology showed intrathymic ectopic parathyroid adenoma. Video-assisted thoracoscopic surgery was performed to remove the ectopic parathyroid adenoma. Neck ultrasonography and Tc-99m-sestamibi (MIBI) scanning with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed ectopic parathyroid adenoma in the thymus. We report the case of a 15-year-old boy with PHPT due to an intrathymic ectopic parathyroid adenoma. Ectopic parathyroid adenomas account for 6%–16% of all parathyroid adenomas and are rare in children but should be considered in cases that present with hypercalcemia. PHPT is typically caused by a single parathyroid adenoma. Hypercalcemia due to primary hyperparathyroidism (PHPT) is uncommon in children.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |