Primer hiperparatiroidizme bağlı şiddetli semptomatik hiperkalsemi nedeniyle acil paratiroidektomi; olgu sunumu

Abstract

rimer hiperparatiroidizm endokrin anomaliler arasında sık gözlenen bir hastalık olup pediatrik popülasyonda oldukça nadir olarak görülmektedir. Hastalar birçok hastalığı taklit eden karın ağrısı, bulantı, yorgunluk, kas güçsüzlüğü gibi nonspesifik semptomlarla başvurabileceği gibi parestezi, yürüme bozukluğu, genel durum bozukluğu gibi semptomlarla da başvurmaktadır. Bu olgu sunumunda acil paratiroidektomi uygulanan 13 yaşındaki erkek hasta tartışıldı. Bu olgu sunumundaki hastanın Acil Servise ateş, halsizlik, şiddetli yorgunluk, sık idrara çıkma ve bulantı şikayetleri ile başvurduğu tespit edildi. Hastaya üst solunum yolu enfeksiyonu tanısı ile medikal tedavi uygulandı. Medikal tedavi sonrası şikayetlerinde gerileme olmaması üzerine tekrar acile başvurması üzerine yapılan ileri tetkiklerde primer hiperparatiroidi tanısı konuldu. Hastaya hiperparatiroidiye yönelik uygulanan medikal tedaviye rağmen semptomları ve hiperkalsemisi devam etmesi üzerine acil paratiroidektomi uygulandı. Medikal tedaviye rağmen yüksek hiperkalsemi ve buna bağlı semptomları devam eden hastalarda acil paratiroidektomi etkin bir tedavi seçeneğidir.

Keywords

• Primer
• hiperparatiroidi
• hiperkalsemi
• paratiroidektomi

Emergency parathyroidectomy for severe symptomatic hypercalcemia due to primary hyperparathyroidism; a case report

Abstract

Primary hyperparathyroidism is a common endocrine abnormality and is rarely seen in the pediatric population. Patients may present with nonspecific symptoms such as abdominal pain, nausea, fatigue, muscle weakness or paresthesia, gait disturbance, general condition disorder, which mimic many diseases. In this case report, a 13-year-old male patient who underwent emergency parathyroidectomy is discussed. The patient in this case report was admitted to the Emergency Department with complaints of fever, malaise, severe fatigue, frequent urination and nausea. Medical treatment was administered with a diagnosis of upper respiratory tract infection. After medical treatment, there was no regression in his complaints and he was admitted to the emergency room again. Further tests were performed and primary hyperparathyroidism was diagnosed. Emergency parathyroidectomy was performed because his symptoms and hypercalcemia persisted despite medical treatment for hyperparathyroidism. Emergency parathyroidectomy is an effective treatment option in patients with persistent hypercalcemia and related symptoms despite medical treatment.

Keywords

• Primary
• hyperparathyroidism
• hypercalsemia
• parathyroidectomy.

References

1. Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Lancet. 2018 Jan 13;391(10116):168-178. doi: 10.1016/S0140-6736(17)31430-7. Epub 2017 Sep 17. PMID: 28923463.
2. Blaine J, Chonchol M, Levi M. Renal control of calcium, phosphate, and magnesium homeostasis. Clin J Am Soc Nephrol. 2015 Jul 7;10(7):1257-72. doi: 10.2215/CJN.09750913. Epub 2014 Oct 6. Erratum in: Clin J Am Soc Nephrol. 2015 Oct 7;10(10):1886-7. PMID: 25287933; PMCID: PMC4491294.
3. Roizen J, Levine MA. Primary hyperparathyroidism in children and adolescents. J Chin Med Assoc. 2012 Sep;75(9):425-34. doi: 10.1016/j.jcma.2012.06.012. Epub 2012 Aug 21. PMID: 22989537; PMCID: PMC3710287.
4. Kollars J, Zarroug AE, van Heerden J, Lteif A, Stavlo P, Suarez L, Moir C, Ishitani M, Rodeberg D. Primary hyperparathyroidism in pediatric patients. Pediatrics. 2005 Apr;115(4):974-80. doi: 10.1542/peds.2004-0804. PMID: 15805373.
5. Dandurand K, Ali DS, Khan AA. Primary Hyperparathyroidism: A Narrative Review of Diagnosis and Medical Management. J Clin Med. 2021 Apr 9;10(8):1604. doi: 10.3390/jcm10081604. PMID: 33918966; PMCID: PMC8068862.
6. Lietman SA, Germain-Lee EL, Levine MA. Hypercalcemia in children and adolescents. Curr Opin Pediatr. 2010 Aug;22(4):508-15. doi: 10.1097/MOP.0b013e32833b7c23. PMID: 20601885; PMCID: PMC2967024.
7. Hayashi S, Oba T, Ichikawa K, Nakamura C, Hara Y, Kanai T, Sato Y, Uehara T, Ito KI. Hypercalcemic crisis caused by primary hyperparathyroidism in a 11-year-old boy: a rare case report and review of the literature. Gland Surg. 2022 Jul;11(7):1279-1286. doi: 10.21037/gs-22-92. PMID: 35935565; PMCID: PMC9346224.
8. Udelsman R, Åkerström G, Biagini C, Duh QY, Miccoli P, Niederle B, Tonelli F. The surgical management of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab. 2014 Oct;99(10):3595-606. doi: 10.1210/jc.2014-2000. Epub 2014 Aug 27. PMID: 25162669.