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Adolescent Hyperparathyroidism: An Updated Contemporary Surgical Experience at a Tertiary Center
Sara Abou Azar1, Joseph Tobias1, Rachel Nordgren2
1Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
The Journal of Surgical Research
|December 18, 2024
Summary
Primary hyperparathyroidism in adolescents often presents with symptoms like kidney stones. Treatment mirrors adult care, using intraoperative parathyroid hormone monitoring and dual preoperative imaging for best results.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Adolescent Medicine
Background:
- Primary hyperparathyroidism (pHPT) is rare in children, with limited data on adolescent cases.
- This study addresses the information gap by reviewing pHPT in patients under 20 years old.
Purpose of the Study:
- To analyze the clinical presentation, surgical management, and outcomes of pHPT in adolescent patients.
- To identify factors influencing recurrence in this population.
Main Methods:
- Retrospective chart review of adolescent patients undergoing pHPT surgery (2004-2023).
- Analysis of presenting symptoms, biochemical data, surgical findings, and follow-up outcomes.
- Evaluation of preoperative imaging (ultrasound, Sestamibi) sensitivity and combined utility.
Main Results:
- 49 adolescents (45% male, median age 16.6 years) were included.
- 71% were symptomatic, most commonly with nephrolithiasis (35%).
- Focused parathyroidectomy (61%) or four-gland exploration (39%) were performed; 86% had single adenoma.
- Combined imaging sensitivity reached 78%; no surgical complications occurred.
- Recurrence rate was 4% at median 61-month follow-up; younger age and sporadic disease predicted lower recurrence.
Conclusions:
- Adolescent pHPT typically presents symptomatically with single-gland disease.
- Treatment should align with adult protocols, incorporating intraoperative parathyroid hormone (PTH) monitoring and two preoperative imaging modalities.
