Juvenile Hyperparathyroidism in Association With Peptic Ulcer

HYPERPARATHYROIDISM in childhood is a relatively rare occurrence (1,2). The present report is of a 10-year-old child in whom the disease was associated with peptic ulcer. The diagnosis was made difficult by a traumatic fracture of the femur with consequent immobilization. Patient AVAD, the seventh child of a 37-year-old mother, was considered to be in excellent health until 1953, when he manifested fatigue and abdominal distress. As the result of the latter, in August 1954, an appendectomy was performed on the basis of a preoperative diagnosis of acute appendicitis. The pathologic report of the surgical specimen was “possible tuberculoma of the appendix.” Results of tuberculin and histoplasmin skin tests were negative. X-ray examination showed a normal chest. The symptoms subsided following operation, and the patient was discharged to the clinic. Because of recurrence of abdominal distress, intravenous pyelograms and upper gastro-intestinal x-ray series were carried out in October 1953. The pyelogram showed a small dense area in the right kidney region, as well as coarsening of the trabecular pattern of the pelvic bone. The gastro-intestinal series showed an active duodenal ulcer, with associated duodenal deformity. Repetition of the series in December showed deformity but no crater. X-ray examination showed the gallbladder to be normal. The patient received “usual ulcer therapy” with improvement, and was not seen from January until June, 1954. On June 21, he sustained a fracture of the right femur as the result of an automobile accident. X-ray examination of the pelvis showed increased coarsening of the trabecular markings. The bone in the region of the fracture was not remarkable. Dental films revealed essentially normal lamina dura.