A Case of Primary Hyperparathyroidism Secondary to Parathyroid Adenoma in a Pediatric Patient

•Although common in adults, primary hyperparathyroidism is a rare condition in children.•The most common etiology of hyperparathyroidism in children is single parathyroid adenoma.•The most common presentation of primary hyperparathyroidism in children and adolescents is symptomatic hypercalcemia.•Excision of the parathyroid adenoma is the best treatment for children with primary hyperparathyroidism secondary to adenoma. Background/ObjectiveAlthough common in adults, primary hyperparathyroidism (PHPT) is a rare condition in children with the most common etiology being solitary parathyroid adenoma (PTA). Typical presentation is symptomatic hypercalcemia. Management of PHTP secondary to PTA requires excision of the adenoma.Case ReportA 13-year-old male presented due to orbital cellulitis and was noted to have hypercalcemia. Despite this, the patient was curiously asymptomatic. Further investigations yielded an elevated parathyroid hormone (PTH) and normal urine calcium-to-creatinine ratio making the most likely cause of hypercalcemia PHTP secondary to PTA. Imaging demonstrated PTA.Patient underwent parathyroidectomy with the pathology demonstrating PTA. Post-operatively, PTH levels were undetectable, so the patient was treated with calcitriol and calcium supplementation for one month and four months, respectively. Genetic work up for MEN1 and RET mutations was negative.DiscussionPTA is the most common cause of PHPT. Adenomas are mostly sporadic or may be a manifestation of an inheritable syndrome such as multiple endocrine neoplasia. Although symptomatic disease is more common in children, our patient denied any hypercalcemia symptoms.Distinguishing biochemical features of PHPT due to PTA is high or inappropriately normal PTH level in the context of high-normal or elevated serum calcium. Urinary calcium excretion is usually normal or high.PTAs are localized by ultrasound and Tc-99m-Sestamibi scintigraphy. Management includes parathyroidectomy and monitoring for post-operative hypocalcemia.ConclusionIn a child presenting with hypercalcemia and elevated PTH, it is important to consider PHPT secondary to PTA, because an early diagnosis will aid in preventing complications from hypercalcemia. Although common in adults, primary hyperparathyroidism (PHPT) is a rare condition in children with the most common etiology being solitary parathyroid adenoma (PTA). Typical presentation is symptomatic hypercalcemia. Management of PHTP secondary to PTA requires excision of the adenoma. A 13-year-old male presented due to orbital cellulitis and was noted to have hypercalcemia. Despite this, the patient was curiously asymptomatic. Further investigations yielded an elevated parathyroid hormone (PTH) and normal urine calcium-to-creatinine ratio making the most likely cause of hypercalcemia PHTP secondary to PTA. Imaging demonstrated PTA. Patient underwent parathyroidectomy with the pathology demonstrating PTA. Post-operatively, PTH levels were undetectable, so the patient was treated with calcitriol and calcium supplementation for one month and four months, respectively. Genetic work up for MEN1 and RET mutations was negative. PTA is the most common cause of PHPT. Adenomas are mostly sporadic or may be a manifestation of an inheritable syndrome such as multiple endocrine neoplasia. Although symptomatic disease is more common in children, our patient denied any hypercalcemia symptoms. Distinguishing biochemical features of PHPT due to PTA is high or inappropriately normal PTH level in the context of high-normal or elevated serum calcium. Urinary calcium excretion is usually normal or high. PTAs are localized by ultrasound and Tc-99m-Sestamibi scintigraphy. Management includes parathyroidectomy and monitoring for post-operative hypocalcemia. In a child presenting with hypercalcemia and elevated PTH, it is important to consider PHPT secondary to PTA, because an early diagnosis will aid in preventing complications from hypercalcemia.