Pediatric Primary Hyperparathyroidism: Experience in a Tertiary Care Referral Center in a Developing Country Over Three
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ORIGINAL SCIENTIFIC REPORT
Pediatric Primary Hyperparathyroidism: Experience in a Tertiary Care Referral Center in a Developing Country Over Three Decades Vikram Sharanappa1 • Anjali Mishra1 • Vijayalakshmi Bhatia2 • Sabaretnam Mayilvagnan1 Gyan Chand1 • Gaurav Agarwal1 • Amit Agarwal1 • Saroj Kanta Mishra1
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Accepted: 20 September 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background There is limited experience in managing pediatric primary hyperparathyroidism (PHPT). The aim of this study was to analyze the clinical presentation and outcome of surgery in children with PHPT managed at a tertiary referral center. Methods This retrospective study (September 1989–August 2019) consisted of 35 pediatric PHPT patients (\ 18 years) who underwent parathyroidectomy. Clinico-pathologic profile and outcome were noted. Results The mean age of cohort was 15.2±2.9 years and girls outnumbered boys (M:F = 1:1.9). Familial and symptomatic disease was noted in 8.5 and 94.3% cases, respectively. Skeletal manifestations (83%) were the commonest followed by renal (29%). Fifty-four percent children had skeletal fractures, and 23% were bed-ridden. Among rare manifestations, hypercalcemic crisis, recurrent pancreatitis and stigmata of rickets were observed in 2.8, 11.4 and 14.2% children, respectively. Mean calcium concentration was 12.1 ± 2.0 mg/dl and PTH 91.8 ± 66.5 pmol/L. The sensitivity of preoperative imaging in parathyroid localization was 91.4%. Minimally invasive parathyroidectomy (MIP) was performed in 40% cases. Parathyroid adenoma was observed in 91.4% patients, whereas remaining had hyperplasia. Thirty-four percent suffered from Hungry bone syndrome in postoperative period. The cure rate following primary surgery was 97%. One child with persistent PHPT had successful reoperation. Median follow-up was 5 (1–17) years, and no recurrence or familial disease was revealed during this period. Conclusion Majority of pediatric patients present with symptomatic PHPT. Despite relatively high incidence of familial disease select pediatric patients can undergo successful MIP.
A part of this study was presented in 79th Annual Conference of the Association of Surgeons of India (ASICON 2019), December 18–21, 2019, Bhubaneswar. Sharanappa Vikram and Anjali Mishra contributed equally to the study. & Anjali Mishra [email protected]; [email protected] 1
Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226 014, India
2
Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Introduction The occurrence of primary hyperparathyroidism (PHPT) is rare in pediatric population [1–4]. The estimated incidence is around 2–5/100,000. The rarity and thus-limited clinical experience of this condition probably contributes to delayed diagnosis and more severe presentation of this disease in children who often present with end organ damage, including pathologic bone fractures, osteitis fibrosa cystica, nephrolithia
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