Endocrine Abstracts

JOINT3810

Introduction: Parathyroid adenoma is a rare cause of primary hyperparathyroidism in children, with a prevalence of 2–5 per 100, 000. Pediatric cases have been reported to often present with more severe manifestations and higher rates of end-organ involvement, though symptoms may be nonspecific and lead to delayed diagnosis. This study evaluates the clinical characteristics, management, and outcomes of pediatric parathyroid adenoma at our center.

Methods: We retrospectively analyzed pediatric patients diagnosed with parathyroid adenoma at our hospital between 2022 and 2024. Patient records were reviewed for clinical presentation, laboratory findings, imaging studies, biochemical evaluations for MEN syndromes, perioperative management, and pathological assessments.

Results: Nine patients (4 females, 5 males; mean age 13. 80 ± 1. 69 years) were included. At diagnosis, the mean serum calcium was 12. 53 ± 0. 97 mg/dL and the mean PTH level was 203. 58 ± 127. 11 ng/l. Surgery was performed 19. 44 ± 14. 84 days after diagnosis, with an average follow-up of 8. 56 ± 7. 18 months. Preoperative imaging included parathyroid ultrasound (100%), sestamibi scintigraphy (88. 89%), and urinary ultrasound (88. 89%), with the left superior gland most commonly affected (44. 44%). Only one patient required a PTH washout study. Biochemical screening for MEN syndromes was performed in 66. 67% of patients, and genetic testing for MEN1, RET, and CDKN1B, performed in three patients, was negative. Notably, no patients had a family history of parathyroid adenoma or nephrocalcinosis. Clinically, 55. 56% of patients were asymptomatic with incidentally detected hypercalcemia, while 44. 44% presented with symptoms such as abdominal pain, gastrointestinal disturbances, and facial acne. Postoperative calcium levels normalized within 2. 33 ± 1. 41 days. No significant difference in preoperative calcium levels was found between symptomatic and asymptomatic groups (P = 0. 240). All pathology was benign. Perioperative management included intravenous hydration (88. 89%), furosemide (88. 89%), pamidronate (22. 22%), calcitriol (44. 44%), and calcium supplementation (55. 56%), with two patients remaining on calcitriol therapy at 15-month follow-up.

Conclusion: Our findings underscore the sporadic nature of pediatric parathyroid adenoma, with no familial cases or nephrocalcinosis observed. Despite benign pathology, the variability in clinical presentation demands high diagnostic vigilance. Early surgical intervention resulted in rapid normalization of calcium levels, though prolonged calcitriol therapy in some patients suggests ongoing endocrine monitoring is essential. Further studies with larger cohorts and extended follow-up are warranted to refine management strategies for this uncommon pediatric condition.