Kollars J, Zarroug AE, van Heerden J, et al: Primary hyperparathyroidism in pediatric patients. Pediatrics 2005;115(4):974-80.
Primary hyperparathyroidism is rare in children, but results in serious consequences if untreated. This article examines 52 children between the ages of 4 and 18 years for a retrospective review of medical records. Symptoms of fatigue, lethargy, headache, nephrolithiasis, nausea, abdominal pain, vomiting, and polydipsia were found in 70% of the children. The median time from onset of symptoms to diagnosis was 24 months. Physical findings were minimal, only four of the children had palpable parathyroid masses. All but two of the children had elevated serum calcium levels, and 85% of the children had elevated parathyroid hormone levels. End-organ damage was found in 44% of the children and included nephrocalcinosis, nephrolithiasis, and bone involvement. While surgical therapy (single-gland parathyroidectomy, subtotal parathyroidectomy, or total parathyroidectomy) was highly effective, it did not eliminate short-term complications, multiple operations, or end-organ damage. The authors recommend screening serum calcium and parathyroid hormone levels on any child with symptoms of fatigue, headache, nausea, abdominal pain, emesis, polydipsia, diarrhea, depression, or joint pain.