An occult ectopic parathyroid adenoma in a pediatric patient: a case report and management algorithm
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Brent D. Bauman
Abstract
Background:
Hyperparathyroidism (HPT) is a rare disease in the pediatric population, and optimal management may be unclear if it is due to an occult parathyroid adenoma. We present a case report of a pediatric patient with an occult, ectopic, supernumerary, parathyroid adenoma.
Case presentation:
A 13-year-old female who initially presented with anxiety was diagnosed with HPT. Preoperative imaging and bilateral neck exploration with four-gland biopsy were negative for any parathyroid adenoma. Postoperative MRI identified a thymic mass. She subsequently underwent video-assisted thoracoscopic thymectomy with resection of an intrathymic parathyroid adenoma.
Conclusions:
The diagnosis of pediatric HPT is increasing. Supernumerary or occult parathyroid adenomas are rare and add complexity to presurgical planning and management. Our case represents the rare occurrence of a pediatric ectopic supernumerary occult parathyroid adenoma treated with a two-stage approach utilizing multiple imaging studies. We provide a review of the pathology and propose an algorithmic approach to manage these complex patients.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Durkin E, Nichol P, Lund D, Chen H, Sippel R. What is the optimal treatment for children with primary hyperparathyroidism? J Pediatr Surg 2010;45:1142–6.10.1016/j.jpedsurg.2010.02.074Search in Google Scholar PubMed
2. Kollars J, Zarroug A, van Heerden J, Lteif A, Stavlo P, et al. Primary hyperparathyroidism in pediatric patients. Pediatrics 2005;115:974–80.10.1542/peds.2004-0804Search in Google Scholar PubMed
3. Lou I, Schneider D, Sippel R, Chen H, Elfenbein D. The changing pattern of diagnosing primary hyperparathyroidism in young patients. Am J Surg 2017;213:146–50.10.1016/j.amjsurg.2016.03.019Search in Google Scholar PubMed PubMed Central
4. Lawson M, Miller S, Ellis G, Filler R, Kooh S. Primary hyperparathyroidism in a paediatric hospital. Q J Med 1996;89:921–32.10.1093/qjmed/89.12.921Search in Google Scholar PubMed
5. Belcher R, Metrailer A, Bodenner D, Stack Jr B. Characterization of hyperparathyroidism in youth and adolescents: a literature review. Int J Pediatr Otorhinolaryngol 2013;77:318–22.10.1016/j.ijporl.2012.12.008Search in Google Scholar PubMed
6. Roy M, Mazeh H, Chen H, Sippel R. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg 2012;37:102–6.10.1007/s00268-012-1773-zSearch in Google Scholar PubMed
7. Phitayakorn R, McHenry C. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 2006;191:418–23.10.1016/j.amjsurg.2005.10.049Search in Google Scholar PubMed
8. Beland D, Monchick M. 4D Ct – a diagnostic tool to localize an occult parathyroid adenoma in a patient with primary hyperparathyroidism. Med Health R I 2012;95:157–8.Search in Google Scholar
9. Uludag M, Isgor A, Yetkin G, Atay M, Kebudi A, et al. Supernumerary ectopic parathyroid glands. Persistent hyperparathyroidism due to mediastinal parathyroid adenoma localized by preoperative single photon emission computed tomography and intraoperative gamma probe application. Hormones 2009;8:144–9.10.14310/horm.2002.1231Search in Google Scholar PubMed
10. Mancilla E, Levine M, Adzick N. Outcomes of minimally invasive parathyroidectomy in pediatric patients with primary hyperparathyroidism owing to parathyroid adenoma: a single institution experience. J Pediatr Surg 2017;52:188–91.10.1016/j.jpedsurg.2016.01.018Search in Google Scholar PubMed PubMed Central
11. Amer K, Khan A, Rew D, Lagattolla N, Singh N. Video assisted thoracoscopic excision of mediastinal ectopic parathyroid adenomas: a UK regional experience. Ann Cardiothorac Surg 2015;4:527–34.Search in Google Scholar
12. Dhillon V, Pitukcheewanont P, Yeh M, Maceri D. Identifying an ectopic parathyroid adenoma using 4DCT in a pediatric patient with persistent primary hyperparathyroidism. Case Rep Otolaryngol 2013;2013:1–4.10.1155/2013/676039Search in Google Scholar PubMed PubMed Central
13. Çelik A, Divarcı E, Dökümcü Z, Ergün O, Özen S, et al. Intraoperative parathyroid hormone monitoring corroborates the success of parathyroidectomy in children. J Clin Res Pediatr Endocrinol 2014;6:158–62.10.4274/jcrpe.1401Search in Google Scholar
©2017 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Original Articles
- Standard body mass index reference data of prepubescent diabetic Egyptian children
- Frequency and risk factors of depression in type 1 diabetes in a developing country
- Association of obesity and health related quality of life in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study
- Association between urinary phthalates and metabolic abnormalities in obese Thai children and adolescents
- A pilot study of the effect of human breast milk on urinary metabolome analysis in infants
- Assessment of the correlation between the atherogenic index of plasma and cardiometabolic risk factors in children and adolescents: might it be superior to the TG/HDL-C ratio?
- Cardiovascular and metabolic risk in pediatric patients with congenital adrenal hyperplasia due to 21 hydroxylase deficiency
- Application of povidone-iodine at delivery significantly increases maternal urinary iodine but not neonatal thyrotropin in an area with iodine sufficiency
- Influence of topical iodine-containing antiseptics used during delivery on recall rate of congenital hypothyroidism screening program
- Applying targeted next generation sequencing to dried blood spot specimens from suspicious cases identified by tandem mass spectrometry-based newborn screening
- Short Communication
- Initial patient choice of a growth hormone device improves child and adolescent adherence to and therapeutic effects of growth hormone replacement therapy
- Case Reports
- An occult ectopic parathyroid adenoma in a pediatric patient: a case report and management algorithm
- Fetal goitrous hypothyroidism treated by intra-amniotic levothyroxine administration: case report and review of the literature
- Carotid intima media thickness in a girl with sitosterolemia carrying a homozygous mutation in the ABCG5 gene
- Sirolimus in the treatment of three infants with diffuse congenital hyperinsulinism