IMPE Abstracts

Introduction: Primary hyperparathyroidism (PHPT 1) is a rare entity in childhood and adolescence, most cases are diagnosed in patients over 45 years of age, frequently in females, in the pediatric age, mainly affects males, with the exception of neonates in whom there are no differences between the sexes. Most cases occur in children older than 10 years, especially in peripubertal age, and only 5% of all hyperparathyroidism in childhood are diagnosed between 3 months and 10 years. PPH 1 in childhood makes it necessary to rule out polyglandular syndrome, MEN 1 and 2 a. It has a prevalence of 2-5 cases per 100,000 adolescents.

Objective: To report the case of an adolescent with Atypical Parathyroid Adenoma.

Results: A 15-year-old adolescent was admitted to the Pediatric Department at our Hospital with a history of several months of evolution with tachycardia, weight loss, and renal lithiasis with preserved renal function associated with hypercalcemia. She presented lytic-type lesions in the shell, hands and long bones. Due to the level of impregnation, associated malignant disease was suspected. Laboratory assessments after admission revealed a serum levels of calcium 13,1 mg/dl, phosphorus 2,0 mg/dl, magnesium 0.8 mg/dl, Parathormone (PTH) 3000 pg/ml Alkaline Phosphatase (ALP) 1500 UI/L. Urea 0.5 mg/dl Creatinine 0.58 mg/dl. To rule out initial association with multiple endocrine neoplasia type 1 MEN 1, a dosage of Prolactin, Gastrin, Insulin, Growth Hormone (GH) was requested. All values were within normal levels. With the diagnosis of primary hyperparathyroidism subtotal parathyroidectomy and + right thyroid lobectomy was performed, for suspected malignancy. The patient did not present immediate intra-or post-surgical complications. The biopsy revealed an atypical parathyroid adenoma. She required 18 days of intravenous calcium supply.

Conclusion: We report a rare case of PHPT 1 due to atypical parathyroid adenoma in an adolescent. Atypical parathyroid adenoma is a tumor that has characteristics both of typical adenoma and parathyroid carcinoma. The diagnosis is reached by excluding with strict methods the presence of malignancy criteria. Although PHPT 1 is a common endocrine disease in adults, the occurrence in children or adolescents does not exceed 2%. This fact is related to late diagnoses of this pathology. Therefore, experts suggest calcium controls in infants with severe non-specific symptoms.