Primary hyperparathyriodism (PHPT) is associated with either an adenoma or hyperplasia of chief cells of the parathyroid gland. It may occur sporadically, as a single autosomal dominant familial disorder, or as a part of the autosomal dominantly transmitted complex of multiple endocrine neoplasia (MEN). PHPT is relatively rare in children and adolescents(1,2). Patients of PHPT in India are comparatively young and they suffer from overt skeletal and renal manifestations.

A 12-year-old boy presented with a pain in abdomen, decreased appetite, and constipation for three months and severe nausea and vomiting since eight days. Physical examination of the child was unremarkable. Investigations revealed: blood urea 34 mg/dL, creatinine of 1.5 mg/dL, serum calcium level was 19.5 mg/dL, phosphorus 3.2 mg/dL, and serum alkaline phosphatase 563 IU/L. Parathyroid hormone levels were 380.0 pg/mL (12-72 pg/mL). USG abdomen showed small renal calculi in left kidney. Bone changes of hyperparathyroidism were not seen. CT neck showed a well-circumscribed enhancing lesion 1 cm × 0.9 cm at the level of the thyroid lobe suggestive of parathyroid adenoma. Parathyroid scintigraphy with technetium-99m-MIBI showed evidence of tracer activity in the region of upper pole of left lobe of thyroid confirming parathyroid adenoma in that region. Patient subsequently underwent surgery.

PHPT most often associated with parathyroid adenoma(3,4). Clinical manifestation of hypercalcemia includes muscular weakness, anorexia, nausea, vomiting, constipation, polydipsia, polyuria, loss of weight and renal calculi. Osseous changes may include pain in back or extremities, fractures and decrease in height due to compression of vertebra. Surgical removal is recommended. Prognosis is good if the disease is recognized and treated early. When extensive osseous lesions are present, deformities may be permanent(3).

Paridhi Garg,
S.R. Daga,
Department of Pediatrics,
B.J. Medical College,
Pune, India. 

1. Bhansali A, Masoodi SR, Reddy KS, Behera A, das Radotra B, Mittal BR, et al. Primary hyperparathyriodism in North India: A description of 52 cases. Ann Saudi Med 2005; 25: 29-35.

2. Kollars J, Zarrong AE, Rodeberg D. Primary hyperparathyroidism in pediatric patients. Pediatrics 2005; 115: 974-980.

3. Doyle DA, DiGeorge AM. Disorders of the parathyroid. In: Behrman RE, Kleigman RM, Jenson HB eds. Nelson Textbook of Pediatrics, 17th edn. Philadelphia: WB Saunders; 2004: p. 1894-1897.

4. Melliere D, Berrahal D, Simon D. Primary hyperparathyroidism. Relationship of symp-toms to age, sex, calcemia, anatomical lesions and weight of the gland. Presse Med 1995; 24: 1889-1893.