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[Renal lithiasis as a manifestation of primary hyperparathyroidism]
L Soriano Guillén1, M T Muñoz Calvo, C Torrijos Román
1Sección de Endocrinología, Hospital Universitario del Niño Jesús, Departamento de Pediatría, Universidad Autónoma, Madrid, Spain.
Insights
Primary hyperparathyroidism in children, often caused by parathyroid adenoma, can present with hypercalcemia and kidney stones. Surgical removal of the adenoma effectively normalized calcium levels.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Diagnostic Imaging
Background:
- Primary hyperparathyroidism is rare in children, typically caused by parathyroid adenoma.
- It can be asymptomatic, with hypercalcemia detected during routine testing.
- Renal lithiasis is a potential, though less common, presentation.
Observation:
- A 13-year-old boy presented with hypercalcemia and renal lithiasis.
- Cervical magnetic resonance imaging identified a right parathyroid node.
- Cardiolite-Technetium 99 gammagraphy indicated an inferior right parathyroid adenoma.
Findings:
- Surgical removal of the parathyroid adenoma and ectopic tissue was performed.
- Histopathology confirmed a parathyroid adenoma.
- Post-operative normalization of blood calcium levels was achieved.
Implications:
- Cervical MRI and Cardiolite-Technetium 99 gammagraphy are valuable diagnostic tools for pediatric hypercalcemia.
- Parathyroidectomy is an effective treatment for primary hyperparathyroidism in children.
- Early diagnosis and intervention can prevent complications like renal lithiasis.
Abstract:
Primary hyperparathyroidism is an infrequent condition in infancy and is usually due to adenoma. It may be asymptomatic and is suspected when isolated hypercalcemia is detected in routine investigations. We describe the case of a 13-year-old boy with hypercalcemia presenting as renal lithiasis. Cervical magnetic resonance revealed a 13 x 8 x 5 mm-node in the right parathyroid. Gammagraphy with Cardiolite-Technetium 99 suggested an adenoma in the inferior right portion of the parathyroid. Right inferior parathyroidectomy was performed and ectopic tissue, as well as hyperplasia of the parathyroids, was removed. The histopathological diagnosis was adenoma of the parathyroid gland. After surgery blood calcium levels returned to normal. In conclusion, cervical magnetic resonance and gammography with Cardiolite-Technetium 99 should be performed in children presenting hypercalcemia and laboratory results suggestive of primary hyperparathyroidism. Subsequently, parathyroidectomy should be performed.