Faculty Collaboration Database

Single Gland, Ectopic Location: Adenomas are Common Causes of Primary Hyperparathyroidism in Children and Adolescents. World J Surg 2020 May;44(5):1518-1525

Date

01/05/2020

Pubmed ID

31900569

Pubmed Central ID

PMC7124981

DOI

10.1007/s00268-019-05362-8

Scopus ID

2-s2.0-85077256125 (requires institutional sign-in at Scopus site)   16 Citations

Abstract

BACKGROUND: Primary hyperparathyroidism (PHPT) in children and adolescents is uncommon. Data-driven guidelines for management in pediatric patients are limited.

METHODS: We performed a retrospective cohort analysis of all patients (1997-2017) with PHPT ≤ 21 years of age who underwent parathyroidectomy at three institutions. Clinical and demographic variables were analyzed. Primary operative outcome was cure (normocalcemia > 6 months after surgery); secondary outcome was operative success (intraoperative parathyroid hormone decrease of ≥ 50%).

RESULTS: We identified 86 patients with a median age of 17 years (IQR: 14, 19); 64% (n = 55) were female. The mean preoperative serum calcium was 11.7 mg/dL, median parathyroid hormone (PTH) was 110 pg/mL, and median urine calcium was 4.1 mg/kg/24 h. Preoperatively, sestamibi scan localized in 41/71 patients (58%); neck ultrasound localized in 19/44 (43%). The most common pathology at surgery was a single ectopic parathyroid adenoma in 71% (n = 61). A high incidence of ectopic adenomas (25%, n = 22) was observed, most commonly intrathymic (n = 13), followed by tracheoesophageal groove (n = 5), carotid sheath (n = 2), and intrathyroidal (n = 2). Of 56 patients with retrievable data > 6 months postoperatively, cure was achieved in 55 of 56 patients (98%). One patient who presented to us with parathyromatosis require subsequent reoperation.

CONCLUSION: In this multi-institutional series of PHPT in children and adolescents, the majority were sporadic PHPT and were due to a single adenoma. We observed a high incidence of ectopic parathyroid adenomas, most commonly intrathymic. Given the high risk for ectopic adenoma in pediatric patients, parathyroid surgery in children and adolescents should be performed by experienced surgeons.

Author List

Rampp RD, Mancilla EE, Adzick NS, Levine MA, Kelz RR, Fraker DL, Iyer P, Lindeman BM, Mejia VA, Chen H, Wachtel H

Author

Pallavi Iyer MD Chief, Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenoma
Adolescent
Calcium
Choristoma
Female
Humans
Hyperparathyroidism, Primary
Lymphatic Diseases
Male
Parathyroid Glands
Parathyroid Hormone
Parathyroid Neoplasms
Parathyroidectomy
Retrospective Studies
Thymus Gland