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Published on: August 17, 2022
Surgical treatment of children with hyperparathyroidism: single centre experience
S Alagaratnam1, C Brain2, H Spoudeas2
1Centre of Endocrine Surgery, Great Ormond Street Hospitals NHS Trust, University College London Hospital NHS Trust, London, UK.
Insights
Pediatric hyperparathyroidism (HPT) is often symptomatic and genetic. Minimally invasive parathyroidectomy (PTx) is effective for sporadic cases, while total PTx cures familial HPT in children.
Area of Science:
- Pediatric endocrinology
- Surgical management of endocrine disorders
- Genetics of endocrine diseases
Background:
- Hyperparathyroidism (HPT) in children is a rare condition.
- Limited evidence supports surgical management strategies for pediatric HPT.
Purpose of the Study:
- To analyze surgical outcomes for children with HPT.
- To evaluate the effectiveness of different parathyroidectomy (PTx) approaches.
- To assess the role of imaging in pediatric HPT management.
Main Methods:
- Retrospective case series of 29 children under 16 years who underwent parathyroidectomy (PTx) between 1978 and 2012.
- Categorization into neonatal severe hyperparathyroidism (NSHPT), familial HPT, and sporadic HPT.
- Evaluation of imaging accuracy (ultrasound, MIBI) and surgical outcomes.
Main Results:
- 93% of pediatric HPT cases were symptomatic.
- Imaging accuracy for solitary adenomas was 96%, but less effective for hyperplasia and neonates.
- Total PTx was curative for familial HPT; minimally invasive PTx was successful for sporadic HPT in older children.
Conclusions:
- Pediatric HPT is predominantly symptomatic and 46% of cases have a genetic basis.
- Imaging accurately localizes parathyroid adenomas but not hyperplasias.
- Total PTx is curative for familial HPT, and minimally invasive PTx is preferred for sporadic HPT in older children.
Background:
Hyperparathyroidism (HPT) in children is rare and surgical management is supported only by limited evidence.
Methods:
Retrospective case series of all children under the age of 16 years who underwent parathyroidectomy (PTx) between 1978 and 2012.
Results:
We identified 29 children who had surgery for HPT. Six were neonates with neonatal severe hyperparathyroidism (NSHPT) and 23 older children (age range 7-16 years) with sporadic (16) or familial (7) HPT and 93% were symptomatic. Accuracy of ultrasound and MIbi in localising solitary parathyroid adenomas was 96%, but less helpful in hyperplasia and neonates. Children with NSHPT underwent 5 curative total and 1 subtotal PTx (no reoperations). Children with familial HPT underwent 3 total and 4 subtotal PTx. One child with subtotal PTx required a reoperation. Children with sporadic HPT underwent subtotal PTx prior to 1980 (2), exploration and removal of enlarged glands 1980-2002 (5) and minimally invasive PTx since 2002 (9) and all cured by the first operation.
Conclusions:
Our study documents that HPT in children is predominantly symptomatic on presentation and genetically determined in 46% of cases. Imaging is accurate in localising parathyroid adenomas, but not hyperplasias. Total PTx for familial HPT was curative and minimally invasive PTx is the operation of choice for older children with sporadic HPT.
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