Characteristics of primary hyperparathyroidism in adolescents.

AIM: To analyze adolescent primary hyperparathyroidism (PHPT) in India. DESIGN: A retrospective analysis of consecutive medical records of patients with PHPT < or =20 years old who underwent parathyroid surgery at a tertiary care center in north India from 1993 to 2006. METHODS: Fourteen adolescents underwent clinical, biochemical, hormonal, radiological and scintigraphic evaluation for confirmation of PHPT followed by parathyroidectomy. RESULTS: Mean (+/- SD) age of these patients was 15 +/- 3.9 years (8 female). All were symptomatic at presentation except one who had multiglandular involvement as a part of multiple endocrine neoplasia (MEN)-I screening. The common presenting manifestations included bone disease, recurrent nephrolithiasis and pancreatitis. Hypercalcemia was observed in eight of these patients. The mean (+/- SD) serum intact parathyroid hormone was 781 +/- 586 pg/ml. Ultrasonography localized an abnormal parathyroid gland in 12 (92%) of 14 patients, while 99mTc sestamibi scan (performed in 7) localized abnormal parathyroid glands in all (100%). All patients underwent bilateral neck exploration except one with MEN-I, who refused surgery. Twelve patients had single parathyroid adenoma and one had four-gland hyperplasia. Mean follow up was 44.1 months and none showed recurrence. CONCLUSIONS: Children and adolescents with pathological fractures with features of rickets, recurrent urolithiasis and pancreatitis should be screened for PHPT. Surgery is the treatment of choice.