Renal lithiasis as a manifestation of primary hyperparathyroidism

Primary hyperparathyroidism is an infrequent condition in infancy and is usually due to adenoma. It may be asymptomatic and is suspected when isolated hypercalcemia is detected in routine investigations. We describe the case of a 13-year-old boy with hypercalcemia presenting as renal lithiasis. Cervical magnetic resonance revealed a 13 x 8 x 5 mm-node in the right parathyroid. Gammagraphy with Cardiolite-Technetium 99 suggested an adenoma in the inferior right portion of the parathyroid. Right inferior parathyroidectomy was performed and ectopic tissue, as well as hyperplasia of the parathyroids, was removed. The histopathological diagnosis was adenoma of the parathyroid gland. After surgery blood calcium levels returned to normal. In conclusion, cervical magnetic resonance and gammography with Cardiolite-Technetium 99 should be performed in children presenting hypercalcemia and laboratory results suggestive of primary hyperparathyroidism. Subsequently, parathyroidectomy should be performed.