Abstract Background Primary Hyperparathyroidism (PHPT) in children is extremely rare with data from clinical series the only evidence defining our knowledge of this condition and guiding surgical practice in constantly evolving diagnostic and therapeutic landscape. Method Retrospective review (1977 – 2025) of children with PHPT who underwent parathyroidectomy at two tertiary endocrine centres. Results 72 children (0-18 years, 37 boys) had parathyroidectomy for PHPT; 49 sporadic (sPHPT), 14 familial (fPHPT; 10 MEN1, 2 MEN2a, 2 JT-HPT), 9 Neonatal Severe Hyperparathyroidism (NSHPT). Children with sPHPT and NSHPT (90% and 89% symptomatic) presented with severe hypercalcaemia (cCa3.1+/-0.4mmol/L and 4.6+/-1.6mmol/L; p0.05). Children with fPHPT had lower cCa (2.9+/-0.3mmol/L), 31% detected on screening. Ultrasound identified abnormal parathyroid(s) in 95% sPHPT and 90% fPHPT, with Sestamibi concordant in 89%. Imaging performed in 66% of NSHPT cases showed no abnormal parathyroids. 98% of children with sPHPT had single adenoma on histology (67% underwent MIP with IOPTH monitoring). 13 children (93%) with fPHPT had neck exploration with 1-4 parathyroids resected, 1 had MIP (MEN2a). 8 children with NSHPT had 4 and one 3½ gland parathyroidectomies. All children with sPHPT were cured and 1 child with NSHPT had persistent hypercalcaemia. Four children (29%) with fPHPT were re-operated (median 49.5, range 37-59 months). There were no surgical complications. Conclusion Children with PHPT present with severe hypercalcaemia and symptoms. Ultrasound should be first-line imaging for sPHPT. MIP with IOPTH should be the operation of choice for sPHPT. Extent of parathyroidectomy in children with fPHPT remains controversial and should be audited nationally.
Gilbertson-Hart et al. (Fri,) studied this question.