Pediatric hyperparathyroidism

What is pediatric hyperparathyroidism?

Hyperparathyroidism can be a contributor to juvenile osteoporosis, in which the bones become less dense or there isn’t enough bone formation because of decreased calcium intake. This makes the bones weak and allows them to break more easily.

What are the signs and symptoms of pediatric hyperparathyroidism?

• A lump in the neck

• Bones that are easily broken

• Changes in the voice, especially increased hoarseness

• Pain in the abdomen, the side or the back that doesn’t go away

• Pain in the bones

• Trouble swallowing

How is pediatric hyperparathyroidism diagnosed?

Many of the same tests performed to diagnose hyperparathyroidism will be used to diagnose hypoparathyroidism. 

The first step is taking a medical history. Your child’s doctor will ask about symptoms such as cramps or tingling in the hands and feet, or twitching of the muscles of the face. The doctor will also ask about any recent surgeries that may have involved the head and neck.

Tests may include:

• Blood test (calcium level, PTH or magnesium)

• Urinalysis

If cancer is suspected:

• Sestamibi scan - uses a small amount of a radioactive substance that collects in the gland, can determine which gland is abnormal

• CT scan

• Ultrasound

How is pediatric hyperparathyroidism treated?

Medication

For those who aren’t experiencing many symptoms, or if the symptoms are not severe, medication alone may be an effective treatment. Monitoring of kidney function, bone density, and blood levels of calcium and PTH will be done.

Surgery

For many children with hyperparathyroidism caused by a tumor, surgery (parathyroidectomy) may be all that is needed. For the first month afterward or so, the doctor will follow blood calcium levels until they return to normal. Calcium supplements are often prescribed immediately after surgery. 

Secondary hyperparathyroidism

For secondary hyperparathyroidism, treatment of the underlying medical condition may be all that is necessary. If a Vitamin D deficiency is the main issue, then supplementation with Vitamin D may be the only intervention required.

When hyperparathyroidism is related to kidney disease, the only treatment that offers a cure is a kidney transplant. If that is not possible or indicated, medications are often prescribed, including calcimimetic medications that cause the gland to produce less of the hormone, as well as Vitamin D supplements.

Dietary changes also may be suggested. Your child should limit his intake of phosphorus. 

Parathyroid cancer

There are four types of treatment for parathyroid cancers:

1. Surgery is the most common, and because this type of cancer grows very slowly, this is often a cure.

2. High-energy X-rays, or radiation therapy can be applied from outside the body (external) or implanted directly at the location of the cancer, depending on its type and stage.

3. Chemotherapy uses drugs that kill cancer cells or stops them from dividing.

4. Supportive care is the last option that includes drugs to lessen the problems caused by either the disease or its treatment.