Çocukluk Çağında Hiperkalseminin Nadir Bir Nedeni Paratiroid Adenomu: Bir Olgu Sunumu ve Literatürün Gözden Geçirilmesi

Year 2014, Volume: 12 Issue: 2, 107 - 111, 01.09.2014

Ahmet Anık Gönül Çatlı Pınar Edem Özlem Bağ Ayhan Abacı Ece Böber

https://doi.org/10.4274/jcp.30602

Abstract

Primer hiperparatiroidi çocuklarda çok nadir olarak görülen ve genellikle erişkin dönemde tanı konan bir hastalıktır. Paratiroid bezlerin bir veya daha fazlasında parathormon sentezinde artış sonucu ortaya çıkar. Çocuklarda görülme sıklığı 2-5/100,000 iken erişkinde bu oran 1/1000’dir. Tanı anında primer hiperparatiroidili çocukların %73-94’ünde hiperkalsemi ile ilgili semptomlar gözlenmektedir. Çocukluk çağında gerek semptomların özgül olmaması, gerekse de hastalığın erken dönemlerinde hiperkalseminin epizodik olması bu hastalarda nefrokalsinozis, nefrolitiyazis, akut pankreatit ve kemik tutulumu gibi hedef organ hasarının daha sık gözlenmesine neden olmaktadır. Tüm bu nedenlerden ötürü hastalığın erken tanınması ve etkin olarak tedavi edilmesi hedef organ hasarının engellenmesi açısından oldukça önemlidir. Bu olgu sunumunda hiperkalsemi ile ilişkili semtomları olmayan, rastlantısal olarak serum kalsiyum ve parathormon düzeyi yüksek saptanan ve hedef organ hasarı gelişmemiş paratiroid adenomlu 11 yaşında bir erkek olgu -nadir görülmesi nedeni ile- literatür bilgisi eşliğinde sunulmuştur

Keywords

Hiperkalsemi, hiperparatiroidi, paratiroid adenomu

A Rare Cause of Hypercalcemia in Childhood; Parathyroid Adenoma: Case Report and Review of the Literature

Abstract

Hyperparathyroidism is very rare in children incidence of 2-5 in 100 000 and occurs predominantly in adults incidence of 1 in 1000 . It is caused by increased synthesis of parathormone PTH by one or more pathologically effected parathyroid glands. HPT symptoms are usually non-specific and hypercalcemia may only be episodic in early period and these characteristics are the causes of late recognition and diagnosis of pediatric HPT which can culminate with endorgan damage. At the time of the diagnose 73-94% of PHPT cases in young patients are recognised as a symptomatic, and end-organ involvement, such as nephrocalcinosis, nephrolithiasis, acute pancreatitis, or bone involvement is not rare which is highly related to the prognosis. Therefore, early recognition and evaluation of symptoms would give a chance to prevent negative outcomes. In this case report we describe an incidentally diagnosed parathyroid adenoma in 11 year old asymptomatic male patient with no end-organ involvement

Keywords

Hypercalcemia, hyperparathyroidism, parathyroid adenoma

References

• 1. Kollars J1, Zarroug AE, van Heerden J, Lteif A, Stavlo P, Suarez L, et al. Primary hyperparathyroidism in pediatric patients. Pediatrics 2005;115:974-80.
• 2. Harman CR, van Heerden JA, Farley DR, Grant CS, Thompson GB, Curlee K. Sporadic primary hyperparathyroidism in young patients: a separate disease entity? Arch Surg 1999;134:651-5.
• 3. Damiani D, Aguiar CH, Bueno VS Damiani D, Aguiar CH, Bueno VS, et al. Primary hyperparathyroidism in children: patient report and review of the literature. J Pediatr Endocrinol Metab 1998;11:83-6.
• 4. Makhdoomi KR, Chalmers J, Campbell IW, Browning GG. Delayed diagnosis of juvenile primary hyperparathyroidism. J R Coll Surg Edinb 1996;41:351-3.
• 5. Huang CB, Huang SC, Chou FF, Chen WJ. Primary hyperparathyroidism in children: report of a case and a brief review of the literature. J Formos Med Assoc 1993;92:1095-8.
• 6. Mallet E. Primary hyperparathyroidism in neonates and childhood. The French experience (1984-2004). Horm Res 2008;69:180-8.
• 7. Li CC, Yang C, Wang S, Zhang J, Kong XR, Ouyang J. A 10-year retrospective study of primary hyperparathyroidism in children. Exp Clin Endocrinol Diabetes 2012;120:229-33.
• 8. Loh KC, Duh QY, Shoback D, Gee L, Siperstein A, Clark OH. Clinical profile of primary hyperparathyroidism in adolescents and young adults. Clin Endocrinol (Oxf) 1998;48:435-43.
• 9. Hsu SC, Levine MA. Primary hyperparathyroidism in children and adolescents: the Johns Hopkins Children’s Center experience 1984-2001. J Bone Miner Res 2002;17:44-50.
• 10. Libansky P, Astl J, Adamek S Nanka O, Pafko P, Spackova J, et al. Surgical treatment of primary hyperparathyroidism in children: report of 10 cases. Int J Pediatr Otorhinolaryngol 2008;72:1177- 82.
• 11. Rapaport D, Ziv Y, Rubin M, Huminer D, Dintsman M. Primary hyperparathyroidism in children. J Pediatr Surg 1986;21:395-7.
• 12. Bhadada SK, Bhansali A, Dutta P, Behera A, Chanukya GV, Mittal BR. Characteristics of primary hyperparathyroidism in adolescents. J Pediatr Endocrinol Metab 2008;21:1147-53.
• 13. Patel CN, Salahudeen HM, Lansdown M, Scarsbrook AF. Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol 2010;65:278-87.
• 14. Lumachi F, Zucchetta P, Marzola MC Boccagni P, Angelini F, Bui F, et al. Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol 2000;143:755-60.
• 15. Siperstein A, Berber E, Mackey R, Alghoul M, Wagner K, Milas M. Prospective evaluation of sestamibi scan, ultrasonography, and rapid PTH to predict the success of limited exploration for sporadic primary hyperparathyroidism. Surgery 2004;136:872-80.
• 16. De Feo ML, Colagrande S, Biagini C Tonarelli A, Bisi G, Vaggelli L, et al. Parathyroid glands: combination of (99m)Tc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 2000;214:393-402.
• 17. Bergson EJ, Sznyter LA, Dubner S, Palestro CJ, Heller KS. Sestamibi scans and intraoperative parathyroid hormone measurement in the treatment of primary hyperparathyroidism. Arch Otolaryngol Head Neck Surg 2004;130:87-91.
• 18. Mandell DL, Genden EM, Mechanick JI, Bergman DA, Diamond EJ, Urken ML. The influence of intraoperative parathyroid hormone monitoring on the surgical management of hyperparathyroidism. Arch Otolaryngol Head Neck Surg 2001;127:821-7