Primary hyperparathyroidism in Thai children: case series and literature review

Background: Primary hyperparathyroidism is a common disease in adults, but extremely rare in the pediatric age group. To our knowledge, pediatric primary hyperparathyroidism has never been reported in Thailand. Objectives: To describe 3 cases of primary hyperparathyroidism presenting in Thai children with different clinical manifestations. Methods: Cases of primary hyperparathyroidism in 3 Thai pediatric patients are reported herein, with a brief literature review. Results: Three patients are described. The first patient, a 14-year-old Thai girl, presented with progressively worsening bowlegs and lordosis of the spine for 1.5 years. The second patient, a 15-year-old Thai boy, presented with a history of hip pain and constipation for 3 years. The third patient, an obese 11-year-old Thai boy, presented with acute abdominal pain, which was initially incorrectly diagnosed as acute pancreatitis. Conclusions: The clinical symptoms of hyperparathyroidism in Thai children are nonspecific at an early stage of the disease. The diagnoses are usually delayed and the patients therefore suffer complications of long-term hypercalcemia such as bone deformities or renal nephrocalcinosis. We recommend initial laboratory screening in pediatric patients with nonspecific symptoms and complaints of persistent bone pain. Appropriate investigations to confirm or eliminate primary hyperparathyroidism should be made, as an early diagnosis can facilitate early treatment and prevent the organ damage that can result from delayed diagnosis. Keywords: Hypercalcemia, hyperparathyroidism, parathyroid adenoma, parathyroid hyperplasia