Primary hyperparathyroidism in children and adolescents.

Objective. Primary hyperparathyroidism (PHPT) in children and adolescents is a rare condition. Awareness should improve in order to lower threshold for screening and allow intervention before serious and permanent sequelac occur. Methods. A retrospective analysis of 15 children and adolescents with PHPT (age <20 yr) seen in our clinic between 1993 and 2006. Results. Mean age of patients was 17.73 yr (Range - 13-20, Male-3: Female-12). Average duration of symptoms was 18.87 (range: 0-48) mo. Clinical features at presentation included bone pain (86.67%), proximal myopathy (46.67%), bony deformities (53.33%), fractures (60%), palpable osteitis fibrosa cystica (33.3%), renal calculi (40%), palpable neck swelling (13.3%) and acute pancreatitis (6.67%). None had positive family history or features suggestive of multiple endocrine neoplasia (MEN). After biochemical confirmation, tumor was localised in all prior to surgery. Histopathology confirmed adenoma in all cases. Post-operative hungry bone syndrome occurred in 33.3%. Conclusion. PHPT is more common in females. Presentation of the disease is similar to their adult counterparts except for more severe bone disease and less severe renal disease. MEN and familial non-MEN PHPT do not constitute a major cause of pediatric PHPT as against to worldwide data. The incidence of hyperplasia as a cause of PHPT is rare in our pediatric population.

Drugs and thyroid.

Drugs can affect thyroid functional status in numerous ways. They may influence thyroid homeostasis at any level from their synthesis, secretion, transport or end-organ action resulting in hypothyroidism or hyperthyroidism. Amiodarone is an important drug in this group. The effects of amiodarone on thyroid function result from iodine release and intrinsic drug properties. Both amiodarone-induced thyrotoxicosis (AIT) and amiodarone -induced hypothyroidism (AIH) may develop in apparently normal thyroid glands or in glands with preexisting, clinically silent abnormalities. Treatment of AIH consists of thyroxine replacement while continuing or discontinuing amiodarone therapy. In type I AIT the main medical treatment consists of simultaneous administration of thionamides and potassium perchlorate, while in type II AIT, glucocorticoids are the most useful therapeutic option. It is important to evaluate patients before and during amiodarone therapy. The list of drugs affecting thyroid function is long with new drugs being added. Some of them are clinically important while others just produce diagnostic dilemmas. The possible effect of drugs on the results of thyroid-function tests should always be considered while making decisions regarding patient care.