Childhood Sustained Hypercalcemia: A Diagnostic Challenge

Area of Science:

• Pediatric Endocrinology
• Calcium Metabolism Disorders
• Clinical Pediatrics

Background:

• Hypercalcemia in children is a rare condition with significant potential for severe complications.
• Delayed diagnosis is common due to non-specific or absent symptoms.

Purpose of the Study:

• To highlight the presentation, diagnosis, and management of childhood hypercalcemia.
• To emphasize the importance of early intervention in preventing serious complications.

Main Methods:

• Retrospective review of children with sustained hypercalcemia (2006-2016).
• Classification into parathyroid hormone (PTH)-dependent and PTH-independent groups.
• Analysis of diagnosis, treatment, clinical course, and complications.

Main Results:

• Twenty pediatric patients evaluated; 30% were asymptomatic, 20% had normal physical exams.
• Median diagnostic delay was 45 days; common etiologies included primary hyperparathyroidism, idiopathic infantile hypercalcemia (IIH), and malignancy.
• Nephrocalcinosis was the most frequent complication (45%); malignancy and neonatal severe hyperparathyroidism were treatment-resistant.

Conclusions:

• Childhood hypercalcemia often presents with non-specific symptoms, leading to diagnostic delays.
• Prompt diagnosis and intervention are crucial to avoid serious complications.
• Long-term follow-up is necessary, particularly for cases of IIH with resistant hypercalciuria.