Characteristics of primary hyperparathyroidism in adolescents

To analyze adolescent primary hyperparathyroidism (PHPT) in India.

A retrospective analysis of consecutive medical records of patients with PHPT < or =20 years old who underwent parathyroid surgery at a tertiary care center in north India from 1993 to 2006.

Fourteen adolescents underwent clinical, biochemical, hormonal, radiological and scintigraphic evaluation for confirmation of PHPT followed by parathyroidectomy.

Mean (+/- SD) age of these patients was 15 +/- 3.9 years (8 female). All were symptomatic at presentation except one who had multiglandular involvement as a part of multiple endocrine neoplasia (MEN)-I screening. The common presenting manifestations included bone disease, recurrent nephrolithiasis and pancreatitis. Hypercalcemia was observed in eight of these patients. The mean (+/- SD) serum intact parathyroid hormone was 781 +/- 586 pg/ml. Ultrasonography localized an abnormal parathyroid gland in 12 (92%) of 14 patients, while 99mTc sestamibi scan (performed in 7) localized abnormal parathyroid glands in all (100%). All patients underwent bilateral neck exploration except one with MEN-I, who refused surgery. Twelve patients had single parathyroid adenoma and one had four-gland hyperplasia. Mean follow up was 44.1 months and none showed recurrence.

Children and adolescents with pathological fractures with features of rickets, recurrent urolithiasis and pancreatitis should be screened for PHPT. Surgery is the treatment of choice.