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Clinical Insights and Surgical Management of Pediatric Parathyroid Adenoma: Outcomes and Challenges
A Manasa1, Gowri Shankar1, Vinay Jadhav1
1Department of Pediatric Surgery, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India.
Insights
Pediatric primary hyperparathyroidism (PHPT) due to parathyroid adenoma requires prompt diagnosis. Surgical removal of adenoma is effective, but careful postoperative care is crucial to manage complications like hungry bone syndrome.
Area of Science:
- Pediatric Endocrinology
- Surgical Oncology
- Pediatric Surgery
Background:
- Primary hyperparathyroidism (PHPT) is a rare pediatric endocrine disorder.
- Parathyroid adenoma is the predominant cause in children, often leading to delayed diagnosis and significant morbidity.
Purpose of the Study:
- To analyze clinical features, diagnosis, and management of pediatric PHPT secondary to parathyroid adenoma.
- To evaluate surgical outcomes and postoperative care in children with PHPT.
Main Methods:
- Prospective analysis of six children diagnosed with PHPT secondary to parathyroid adenoma between 2015 and 2024.
- Data collected included demographics, clinical signs, biochemical and radiological findings, surgical procedures, and postoperative management.
Main Results:
- The study included six children (mean age 13.8 years) with a mean diagnostic delay of 3 years.
- All presented with musculoskeletal deformities, elevated serum calcium, and parathyroid hormone levels.
- Imaging confirmed parathyroid adenoma with 100% sensitivity; surgical excision was successful, with all patients experiencing hungry bone syndrome requiring calcium supplementation.
Conclusions:
- Timely diagnosis and intervention for pediatric PHPT are essential to prevent permanent disabilities.
- Effective surgical management and postoperative care significantly improve patient outcomes in pediatric PHPT.
Introduction:
Primary hyperparathyroidism (PHPT) is a rare disorder in children, predominantly caused by parathyroid adenoma, often leading to delayed diagnosis and significant morbidity.
Subjects And Methods:
A prospective analysis of children with PHPT secondary to parathyroid adenoma, study period from 2015 to 2024 at a single institution. Data evaluated included demographics, clinical manifestations, biochemical and radiological features, surgical interventions, and postoperative care.
Results:
Six children (4 males, and 2 females) with a mean age of 13.8 years (range 7-17) were evaluated. The mean duration from symptom onset to diagnosis was 3 years. All children presented with musculoskeletal deformities and exhibited elevated serum calcium (mean 12.48 mg/dL) and serum parathyroid hormone levels (1789-2500 picograms per milliliter (pg/mL)). Imaging with ultrasonogram and Isotope scan was successful in confirming the location of parathyroid adenoma with 100% sensitivity. Surgical excision was successful, and all patients developed hungry bone syndrome, requiring calcium supplementation. The mean serum calcium at discharge was 8.68 mg/dL, with no recurrence noted during an average follow-up of 9 years.
Discussion:
Pediatric PHPT necessitates a high index of suspicion for timely diagnosis and intervention to prevent development of permanent disabilities. Effective surgical management and postoperative care can significantly enhance patient outcomes.
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