Öz
Hypercalcemia is a rare but serious metabolic condition that may lead to end-organ damage. Primary hyperparathyroidism is a rare disease in children and adolescents and parathyroid adenoma is the most common cause. Most of patients are clinically symptomatic and may present signs or symptoms of hypercalcemia. The aim of this report is to describe two case of hypercalcemia due to parathyroid adenoma presenting with different clinical findings.
14 years old male patient with abdominal pain, vomiting and nausea were diagnosed with acute pancreatitis. His laboratory findings were elevated amylase and lipase levels, hyperglycemia, hypercalcemia and hyperparathyroidism. Parathyroid scintigraphy showed the presence of an adenoma. Normocalcemia was provided with pamidronate and hyperglycemia was treated with insulin. Adenoma excision was performed after acute pancreatitis was recovered with replacement therapy. After the surgery, diabetes mellitus persisted and he had a hungry bone syndrome.
Other patient was a 12-year-old male patient presented with complaints of anorexia, weakness, constipation and nausea. He had hypercalcemia, hypophosphatemia and hyperparathyroidism. Parathyroid adenoma was detected with parathyroid scintigraphy. Adenoma excision was performed and postoperatively he had a hungry bone syndrome.
Hypercalcemia associated with primary hyperparathyroidism is rare but generally symptomatic in children and adolescents. It should be kept in mind in the differential diagnosis of hypercalcemia and patients should be protected from complications and permanent damage.
Anahtar Kelimeler
Hypercalcemia Paratyroid Adenoma Primary hyperparathyroidism
Kaynakça
- Referans1 Lietman SA, Germain-Lee EL, Levine MA. Hypercalcemia in children and adolescents. Curr Opin Pediatr 2010;22:508–15.
- Referans2 Davies JH, Shaw NJ. Investigation and management of hypercalcaemia in children. Arch Dis Child 2012;97:533–38.
- Referans3 Roizen J, Levine MA. Primary hyperparathyroidism in children and adolescents. J Chin Med Assoc 2012;75:425–34.
- Referans4 Reeve TS, Delbridge LW. Pancreatitis following parathyroid surgery. Ann Surg 1982;195:158-62
- Referans5 Belcher R, Metrailer AM, Bodenner DL, Stack BC. Characterization of hyperparathyroidism in youth andadolescents: a literature review. Int J Pediatr Otorhinolaryngol 2013;77:318-322.
- Referans6 Abu-El-Haija M, Kumar S, Quiros JA, et al. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr Jan 2018;66(1):159-76.
- Referans7 Werlin SL, Kugathasan S, Frautschy BC. Pancreatitis in children. J Pediatr Gastroenterol Nutr 2003;37(5):591–5.
- Referans8 Egea Valenzuela J, Belchí Segura E, Sánchez Torres A, CarballoAlvarez F. Acute pancreatitis associated with hypercalcemia. A report of two cases. Rev EspEnferm Dig 2009;101:65-9.
- Referans9 Kurtoğlu S, Akın L, Kendirci M, Çağlı S, Özgöçmen S. An Unusual Presentation of Parathyroid Adenoma in an Adolescent: Calcific Achilles Tendinitis. J Clin Res Pediatr Endocrinol 2015;7(4):333-335.
- Referans10 Khan AA, Hanley DA, Rizzoli R, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. OsteoporosInt 2017;28: 1–19.
- Referans11 Smith FB, Cooke RT. Acute fatal hyperparathyroidism. Lancet 1940;2:650‑1.
- Referans12 Kota SK, Krishna SV, Lakhtakia S, Modi KD. Metabolic pancreatitis: Etiopathogenesis and management. Indian J Endocrinol Metab 2013;17:799‑805.
- Referans13 Cope O, Culver PJ, MIxter CG, Nardi GL. Pancreatitis, a diagnostic clue to hyperparathyroidism. Ann Surg 1957;145:857-863.
- Referans14 Banks PA. Epidemiology, natural history, and predictors of disease outcome in acute and chronic pancreatitis. Gastrointest Endosc 2002;56:S226–30.
- Referans15 Felderbauer P, Karakas E, Fendrich V, et al. Pancreatitis risk in primary hyperparathyroidism: relation to mutations in the SPINK1 trypsin inhibitor (N34S) and the cystic fibrosis gene. Am J Gastroenterol 2008;103:368-374.
- Referans16 Gardner TB, Vege SS, Pearson RK, et al. Fluid resuscitation in acute pancreatitis. Clin Gastroenterol Hepatol 2008;6:1070–6.
- Referans17 BasurtoOna X, Rigau Comas D, Urrutia G. Opioids for acute pancreatitis pain. Cochrane Database Syst Rev 2013;(7):CD009179.
- Referans18 Khan MI, Waguespack SG, Hu MI. Medical management of postsurgical hypoparathyroidism. Endocr Pract 2011;17(Suppl1):18-25.
- Referans19 Kim KM, Park JB, Bae KS, Kang SJ. Hungry bone syndrome after parathyroidectomy of a minimally invasive parathyroid carcinoma. J Korean Surg Soc 2011;81:344-349.
Öz
Hiperkalsemi, uç organ hasarına yol açabilen nadir fakat ciddi bir metabolik bozukluktur. Primer hiperparatiroidizm, çocuklarda ve ergenlerde nadir görülür ve en sık nedeni paratiroid adenomudur. Hastaların çoğu klinik olarak hiperkalsemi semptomlarını gösterirler. Bu bildirinin amacı, farklı klinik bulgularla ortaya çıkan ve nadir görülen iki ayrı paratiroid adenomu olgusunu tanımlamaktır.
Karın ağrısı, kusma ve bulantı şikayeti ile başvuran 14 yaşında erkek hastaya amilaz ve lipaz seviyelerinin yüksek olması üzerine akut pankreatit tanısı kondu. Bu duruma ek olarak hiperglisemi ve hiperkalsemisi saptanan hastanın PTH değeri oldukça yüksekti. Paratiroid sintigrafisi çekilerek paratiroid adenomu gösterildi. Hastaya pamidronat verilerek normokalsemi sağlandı ve hiperglisemi için insülin tedavisi başlandı. Replasman tedavisi ile akut pankreatit düzeldikten sonra adenom eksizyonu yapıldı. Hastanın posoperatif dönemde aç kemik sendromu gelişti ve tedavi edildi. İzlemde hastanın insülin tedavisine devam edildi.
2. olgu bulantı, iştahsızlık, halsizlik ve kabızlık şikayetleri ile başvuran 12 yaşında erkek hasta idi. Bakılan laboratuar parametrelerinde hiperkalsemi, hipofosfatemi ve hiperparatiroidi saptandı. Paratiroid sintigrafisi ile paratiroid adenomu tespit edildi. Adenom eksizyonu yapıldı ve postoperatif döenmde aç kemik sendromu gelişti.
Primer hiperparatiroidizm ile ilişkili hiperkalsemi nadir olmakla birlikte çocuklarda ve ergenlerde genellikle semptomatiktir. Hastaları komplikasyonlardan ve kalıcı hasarlardan korumak için hiperkalseminin ayırıcı tanısında akılda tutulmalıdır.
Anahtar Kelimeler
Kaynakça
- Referans1 Lietman SA, Germain-Lee EL, Levine MA. Hypercalcemia in children and adolescents. Curr Opin Pediatr 2010;22:508–15.
- Referans2 Davies JH, Shaw NJ. Investigation and management of hypercalcaemia in children. Arch Dis Child 2012;97:533–38.
- Referans3 Roizen J, Levine MA. Primary hyperparathyroidism in children and adolescents. J Chin Med Assoc 2012;75:425–34.
- Referans4 Reeve TS, Delbridge LW. Pancreatitis following parathyroid surgery. Ann Surg 1982;195:158-62
- Referans5 Belcher R, Metrailer AM, Bodenner DL, Stack BC. Characterization of hyperparathyroidism in youth andadolescents: a literature review. Int J Pediatr Otorhinolaryngol 2013;77:318-322.
- Referans6 Abu-El-Haija M, Kumar S, Quiros JA, et al. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr Jan 2018;66(1):159-76.
- Referans7 Werlin SL, Kugathasan S, Frautschy BC. Pancreatitis in children. J Pediatr Gastroenterol Nutr 2003;37(5):591–5.
- Referans8 Egea Valenzuela J, Belchí Segura E, Sánchez Torres A, CarballoAlvarez F. Acute pancreatitis associated with hypercalcemia. A report of two cases. Rev EspEnferm Dig 2009;101:65-9.
- Referans9 Kurtoğlu S, Akın L, Kendirci M, Çağlı S, Özgöçmen S. An Unusual Presentation of Parathyroid Adenoma in an Adolescent: Calcific Achilles Tendinitis. J Clin Res Pediatr Endocrinol 2015;7(4):333-335.
- Referans10 Khan AA, Hanley DA, Rizzoli R, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. OsteoporosInt 2017;28: 1–19.
- Referans11 Smith FB, Cooke RT. Acute fatal hyperparathyroidism. Lancet 1940;2:650‑1.
- Referans12 Kota SK, Krishna SV, Lakhtakia S, Modi KD. Metabolic pancreatitis: Etiopathogenesis and management. Indian J Endocrinol Metab 2013;17:799‑805.
- Referans13 Cope O, Culver PJ, MIxter CG, Nardi GL. Pancreatitis, a diagnostic clue to hyperparathyroidism. Ann Surg 1957;145:857-863.
- Referans14 Banks PA. Epidemiology, natural history, and predictors of disease outcome in acute and chronic pancreatitis. Gastrointest Endosc 2002;56:S226–30.
- Referans15 Felderbauer P, Karakas E, Fendrich V, et al. Pancreatitis risk in primary hyperparathyroidism: relation to mutations in the SPINK1 trypsin inhibitor (N34S) and the cystic fibrosis gene. Am J Gastroenterol 2008;103:368-374.
- Referans16 Gardner TB, Vege SS, Pearson RK, et al. Fluid resuscitation in acute pancreatitis. Clin Gastroenterol Hepatol 2008;6:1070–6.
- Referans17 BasurtoOna X, Rigau Comas D, Urrutia G. Opioids for acute pancreatitis pain. Cochrane Database Syst Rev 2013;(7):CD009179.
- Referans18 Khan MI, Waguespack SG, Hu MI. Medical management of postsurgical hypoparathyroidism. Endocr Pract 2011;17(Suppl1):18-25.
- Referans19 Kim KM, Park JB, Bae KS, Kang SJ. Hungry bone syndrome after parathyroidectomy of a minimally invasive parathyroid carcinoma. J Korean Surg Soc 2011;81:344-349.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Aralık 2021 |
| Gönderilme Tarihi | 20 Aralık 2020 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 60 Sayı: 4 |
