Primary hyperparathyroidism in childhood and adolescence

Objective : The aim of this study was to determine the nature of the presentation and pathology of primary hyperparathyroidism in children and adolescents and to compare these findings with adults.
Methodology : Data were obtained from the Thyroid Surgery Database at Royal North Shore Hospital on all children and adolescents undergoing parathyroid surgery. These results were then compared to data obtained from the last 100 consecutive adult parathyroidectomies.
Results : A total of eight younger patients underwent parathyroidectomy including three children (0–12 years) and five adolescents (13–18 years). A common presentation in the younger age group was hypercalcaemic crisis (50%) with a serum calcium >3.5 mmol/L and clinical signs of calcium intoxication. This compared to the adult age group where only 8% presented with crisis ( P <0.05). Eighty-eight per cent of the younger patients complained of abdominal symptoms compared to only 1% of adults. Seven of eight young patients had sporadic hyperparathyroidism.
Conclusions : Primary hyperparathyroidism, although uncommon in the younger age group, is still most commonly associated with sporadic tumours. Familial syndromes do not constitute a large percentage of patients. Younger patients are more prone to present late with abdominal symptoms, toxicity and hypercalcaemic crisis, presumably due to delayed diagnosis of an uncommon condition in this age group.