Severe hypercalcemia and a pelvic brown tumor in an adolescent with primary hyperparathyroidism: a case report
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CASE REPORT
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Severe hypercalcemia and a pelvic brown tumor in an adolescent with primary hyperparathyroidism: a case report O. Legault1, M. Inman1, N. Moolman2, S. Wiebe3, A. Poulin4 and M. A. Nour1*
Abstract Background: Primary hyperparathyroidism may present in a myriad of manners, varying from an incidental asymptomatic biochemical finding to gastrointestinal, psychiatric, renal, and bone manifestations. While hyperparathyroidism remains a rare diagnosis in the pediatric population, the initial approach to diagnosis and management of hypercalcemia in children is imperative for the general pediatrician. Herein, we describe an adolescent who presented with a lytic bone lesion and severe, symptomatic hypercalcemia due to primary hyperparathyroidism. Case presentation: A 14-year-old male presented with vomiting, constipation, abdominal pain, and lethargy. He had an elevated total corrected calcium of 4.3 mmol/L. He was found to have a large pelvic lytic tumor consistent with a brown tumor due to primary hyperparathyroidism. He received pharmacologic therapy for stabilization of his hypercalcemia, including intravenous saline, intravenous bisphosphonates, and calcitonin. He subsequently received definitive therapy via parathyroidectomy and his post-operative course was complicated by hungry bone syndrome. Long-term follow-up has found full resolution of the lytic lesion and restored calcium homeostasis. Conclusions: We present this case to highlight the possible presentations of hypercalcemia and hyperparathyroidism that are essential for a general pediatrician to recognize to ensure prompt diagnosis and management. Evaluation for hypercalcemia should be considered in patients with suggestive symptoms and physical exam findings. To our knowledge, this patient represents the first reported pediatric case of a pelvic brown tumor in an adolescent. While the multi-systemic complications of hyperparathyroidism may be quite severe, swift and appropriate management may mitigate these clinical outcomes. Keywords: Hyperparathyroidism, Osteitis fibrosa cystica, Hypercalcemia, Hungry bone syndrome, Case report
Background Primary hyperparathyroidism is a rare entity in the pediatric population. The presentation is commonly an incidental biochemical finding with asymptomatic hypercalcemia. If symptomatic, patients may describe fatigue, headache, nausea, abdominal pain, vomiting and * Correspondence: [email protected] 1 Department of Pediatrics, College of Medicine, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, SK S7N 0W8 Saskatoon, Canada Full list of author information is available at the end of the article
polydipsia. End organ complications are also described, including nephrocalcinosis, renal impairment and osteoporosis.[1] Bone manifestations of hyperparathyroidism typically present as a silent preferential loss of bone at cortical sites with reduced bone mineral density and osteoporosis, while osteitis fibrosa cystica or ‘brown tumors’ are a rare manifestation.[2] We report he
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