Endocrine Abstracts

Introduction: A rare cause of hyperparathyroidism in pediatric is parathyroid carcinoma. The variety of clinical manifestations of hyperparathyroidism and the associated hypercalcemia slows down the verification of its primary nature.

Material and methods: Medical records of an inpatient 13y.o child.

Results: Child from 5 pregnancies, 1 delivery. Pregnancy was accompanied by endemic goiter. Delivery at 39-40weeks, physiological. Previous pregnancies-miscarriages. The child was ill during the last year of life. In the debut of the disease, arthralgia of the knee joints, gait disturbance. In the dynamics for 9 months, there is an increase in the deformity of the knee joints, he received inpatient treatment with a diagnosis of “Bilateral dysplastic coxarthrosis with juvenile epiphysiolysis of the femoral heads. Pathological fracture of the upper and middle third of the diaphysis of the left femur with angular displacement between the fragments against the background of fibrous dysplasia”. 10th month of illness, the condition worsened, complained of abdominal pain, thirst, vomiting, weakness, pallor. Urgently hospitalized with a hypercalcemic crisis. In the clinic of the disease there were bone, renal, cardiovascular, gastrointestinal forms, laboratory hyperparathyroidism (up to21448ng/dl), metabolic disorders (hypokalemia, hyponatremia, hypercalcemia up to3.76mmol/l, hyperglycemia, hypoproteinemia, high alkaline phosphatase up to1597.4u/l, alpha-amylase up to318.7u/l, hypercreatininemia, anemia. Instrumental studies confirmed the volumetric formation of the parathyroid gland. Ultrasound of the thyroid gland-hyperplasia and diffuse changes in the parenchyma of the thyroid gland. Node (adenoma?) of the right lobe of the thyroid gland. Adenoma of the parathyroid gland on the right; MRI of the neck and mediastinum-a picture of the neoplasm soft tissues of the neck on the right (adenoma of the parathyroid gland (size3.1-2.0-2.0cm). The child underwent surgery to remove the adenoma of the parathyroid gland, hemithyroidectomy on the right. Cytology (material of the parathyroid gland): corresponds to parathyroid adenoma. Histology (microscopy): parathyroid tumor, nodular structure, with a well-defined fibrous capsule and fibrinous septa dividing the tumor into lobes and trabeculae. Tumor cells with signs of moderate polymorphism. There is a focus of invasion of tumor cells into the capsule. IHC study: Cyclin D1, P53-positive, Ki-67-5%. Conclusion: morphological picture and immunophenotype of parathyroid carcinoma. There are no tumor elements in the thyroid tissue, ICD-0 Code8140/3(Ki-67-5%).

Conclusion: Parathyroid adenoma can be clinically asymptomatic, as well as under the masks of other diseases. In the case of extremely high levels of calcium in the blood and the presence of pronounced symptoms by pediatricians should be alert to hyperparathyroidism.