Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. 1073 (doi:10.1542/peds.2005-0197)

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COMMENTARY

Primary Hyperparathyroidism in Pediatric Patients: Clear-Cut Differences From Adult Patients

Russell W. Chesney, MD

Department of Pediatrics
University of Tennessee Health Science Center
Memphis, TN 38103

Unlike the situation in adults, primary hyperparathyroidism is a rare condition in childhood.¹ Until newer generations of parathyroid hormone assays became available in the mid-1980s, this diagnosis was almost unknown. The newer and more specific assays permit a more secure diagnosis of this endocrine disorder during childhood^1–3 and are of particular value in defining those children with genetic forms of hyperparathyroidism with which >1 sibling may be affected.

In this issue of Pediatrics, Kollars et al² describe 52 patients from a single institution (the Mayo Clinic) who underwent parathyroid gland resection from 1970 to 2000. Two other recent single-center reports, with 11 and 17 patients, respectively,^1,3 describe similar findings but were not published in the pediatric literature. Together these 3 reports encompass 80 patients and define a pattern for the diagnosis and therapy of these children.^1–3 Most pediatric patients with primary hyperparathyroidism are older adolescents, usually >16 years old. Slightly more females than males have been diagnosed. Hypercalcemia was evident in >85% of the patients. Testing of serum calcium and parathyroid hormone was performed in response to nonspecific gastrointestinal symptoms, renal colic, or musculoskeletal or neurologic symptoms. All series noted a delay of months to years before final diagnosis with end-organ involvement (nephrocalcinosis, nephrolithiasis, acute pancreatitis, or bone involvement), a frequent finding at diagnosis. Approximately two thirds of these children have a single adenoma; the remainder, with genetic forms of hyperparathyroidism,⁴ show multiple-gland hyperplasia. These conditions include multiple endocrine neoplasia (MEN) types I and II and non-MEN familial disease.

Although primary hyperparathyroidism is rare in children, the delay in diagnosis may intensify end-organ damage.

	FOOTNOTES

 
Accepted Jan 28, 2005.

Reprint requests to (R.W.C.), Department of Pediatrics, University of Tennessee Health Science Center, 50 N Dunlop, Memphis, TN 38103. E-mail: rchesney{at}utmem.edu

No conflict of interest declared.

	REFERENCES

TOP REFERENCES

 

1. Lawson ML, Miller SF, Ellis G, Filler RM, Kooh SW. Primary hyperparathyroidism in a paediatric hospital. QJM. 1996;89 :921 –932[Abstract/Free Full Text]
2. Kollars J, Zarroug AE, van Heerden J, et al. Primary hyperparathyroidism in pediatric patients. Pediatrics. 2005;115 :974 –980[Abstract/Free Full Text]
3. Hsu SC, Levine MA. Primary hyperparathyroidism in children and adolescents: the Johns Hopkins Children’s Center experience 1984–2001. J Bone Miner Res. 2002;17(suppl 2) :N44–N50
4. Bastepe M, Juppner H, Thakker RV. Parathyroid disorders. In: Pediatric Bone. San Diego, CA: Elsevier Science; 2003:485–508

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PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Chesney, R. W. Search for Related Content PubMed PubMed Citation Articles by Chesney, R. W. Related Collections Endocrinology Social Bookmarking                         What's this?