Asymptomatic primary hyperparathyroidism in children. Newer methods of preoperative diagnosis
D. B. Allen, A. L. Friedman and S. A. Hendricks
An asymptomatic 11-year-old boy was found to have primary hyperparathyroid
secondary to an isolated parathyroid adenoma. This rare disorder of
childhood can have asymptomatic hypercalcemia as its only manifestation.
Parathyroid hormone assays and studies of urinary calcium excretion,
especially the calcium-creatinine clearance ratio, distinguish parathyroid
hormone excess from hypocalciuric forms of hypercalcemia. Real-time
ultrasonography and dual-isotope subtraction scanning provide accurate,
noninvasive, preoperative localization of abnormal parathyroid tissue. The
prognosis of untreated, asymptomatic primary hyperparathyroidism in
children is not known, and the indications for surgery are unclear.
Diagnostic certainty is, therefore, especially important prior to surgical
exploration.
