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Indian Pediatr 2012;49: 156 |
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Parathyroid Carcinoma Presenting as Genu
Valgum
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M Vinodh and Amudha Rajeshwari
Institute of Social Pediatrics, Stanley Medical
College, Chennai, India.
Email: [email protected]
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A 11-years-old male child was brought to our hospital with presenting
complaints of progressive bowing of legs with mild pain 2 months. Past
history and family history were not significant. Vitals and
anthropometry were normal.
X-rays wrist showed fraying but no cupping.
Investigations showed Ionized calcium level 1.627mol/l
(normal-1.12-1.23mmol/l), 24 hour urine calcium 420 mg/day, serum
phosphorus 2.9gm/dL, serum alkaline phosphatase 2820 IU, and vitamin D3
level 18.88 ng/mL (normal 11.1-42.9 ng/mL). Abdomen ultrasound showed
cystitis. Tubular reabsorption of phosphate was 92 (Max 100- min-82).
ABG pH was normal. Ultrasound neck was done for a mass in neck, which
showed enlarged parathyroid gland (right) 2.5 cm 1×1.5 cm. To rule out
multiple endocrine neophasis syndrome MRI brain and abdomen with
contrast was done which revealed no adrenal/pituitary abnormalities. His
parathormone level was 1630 pg/mL (normal 10-69). Tc-99m-MIBI static
study of the neck/mediastinum showed features suggestive of functioning
parathyroid lesion (suggestive of adenoma) in the region of lower pole
of right lobe of thyroid. Excision of the adenoma was done. Child
developed hypocalcemia symptoms on first post operative day and was
treated with parentreal calcium gluconate. He was discharged on 7 th
POD in good health. Pathologic specimen was found to be parathyroid
carcinoma. Subsequently underwent right hemithyroidectomy for the
carcinoma. Currently child is doing well and is under orthopedic follow
up for corrective surgery.
Childhood hyperparathyroidism is rare. Onset during
childhood is usually as a result of a single benign adenoma.
Manifestations are usually after 10 years and have an autosomal dominant
pattern of inheritance. Parathyroid carcinoma is rare in children, and
typically presents with significant hypercalcemia and a palpable neck
mass [1]. At all ages, the clinical manifestations of hypercalcemia of
any cause include muscular weakness, fatigue, headache, anorexia,
abdominal pain, nausea, vomiting, constipation, polydipsia, polyuria,
loss of weight, fever and nephrocalcinoisis. Renal calculi may occur and
may produce renal colic and hematuria. Osseous changes may produce pain
in the back or extremities, disturbances of gait, genu valgum,
fractures, and tumors. Bone presentation is very rare [2]. This case
gains importance not for its rarity but for the fact that parathyroid
carcinoma should also be kept in the back of our mind for onset of genu
valgum in an adolescent.
Acknowledgement: Dr Sujatha Sridharan, Professor,
Institute of Social Pediatrics, and Dr. Srinivasa Raj, Professor, Department of Pediatric
Surgery, Stanley Medical College, Chennai.
References
1. Fiedler AG, Rossi C, Gingalewski CA.
Parathyroid carcinoma in a child: an unusual case of an ectopically
located malignant parathyroid gland with tumor invading the thymus: J
Pediatr Surg. 2009;44:1649-52.
2. Menon PSN, Madhavi N, Mukhopadhyaya S, Padhy AK, Bal CS, Sharma
LK. Primary hyperparathyroidism in a 14 year old girl presenting with
bone deformities. J Paediatr Child Health. 1994;30:441-3.
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