[Asymptomatic, excessive hypercalcemia n a 12-year-old boy].

Area of Science:

• Pediatric Endocrinology
• Oncology
• Biochemistry

Background:

• A 12-year-old boy presented with a 3-week history of an enlarged cervical lymph node and mild fatigue.
• Routine screening revealed significant hypercalcemia (7.3-8.1 mval/l).

Observation:

• Hypercalcemia persisted and rose to 9.2 mval/l despite aggressive fluid management with furosemide and corticosteroid treatment with prednisone.
• Serum phosphate levels were consistently low.
• Other potential causes including malignancy, vitamin D intoxication, immobilization, and familial hypercalcemia were excluded.

Findings:

• Highly elevated serum parathormone levels, despite the existing hypercalcemia, strongly suggested a parathyroid origin.
• Neck ultrasonography further supported the diagnosis.
• Preoperative administration of calcitonin effectively reduced serum calcium levels to 6-7 mval/l.

Implications:

• This case highlights the importance of considering parathyroid adenoma in pediatric patients with unexplained hypercalcemia.
• Early diagnosis and surgical intervention are crucial for managing parathyroid adenoma.
• Understanding the biochemical markers and imaging techniques is vital for accurate diagnosis.