Primary hyperparathyroidism in adolescents: the same but different

Abstract

Purpose

Primary hyperparathyroidism has been studied more extensively in adults than in adolescents. The objective of this study is to define the similarities and differences that exist between these groups.

Methods

A retrospective review of 1,000 primary hyperparathyroidism patients undergoing parathyroidectomy at a single tertiary-care university teaching hospital between 1990 and 2004. All patients 20 years of age or younger comprised our study cohort, and were compared to two historical adult groups.

Results

Of 1,000 parathyroidectomies, 21 (2.1 %) were 20 years of age or younger (adolescent). The adolescents presented with higher serum calcium levels (p < 0.01) more severe symptoms (p = 0.02), more renal stones (p = 0.048), and a higher incidence of hypercalcemic crisis (p = 0.02), when compared with adults. We found that 67 % suffered from a triad of tiredness, weakness, and depression versus 39 % of adults (p = 0.02). Sestamibi scans were less helpful in the adolescents than in adults. Similar to the adults, 86 % of adolescent patients had single gland disease, and 95 % were cured at the first operation.

Conclusion

Adolescents with primary hyperparathyroidism typically have more severe disease than adults. Contrary to popular belief, most adolescents have single gland disease and not hyperplasia associated with a genetic disorder.