The Challenging Management of Hyperparathyroidism in a 9-Year-Old Boy: A Case Report



Tavakolizadeh R ; Alibakhshi A ; Abdolmohamadian S
Source: Tehran University Medical Journal Published:2025

Abstract

Background: Primary hyperparathyroidism is a rare but significant endocrine disorder in pediatric patients; although uncommon, parathyroid adenomas are the most frequently identified cause of primary hyperparathyroidism in this population. Diagnosis and treatment of primary hyperparathyroidism in children, especially in cases caused by parathyroid adenoma, demand careful assessment and require a coordinated and multidisciplinary approach involving endocrinologists, pediatric surgeons, radiologists, and other specialists. Early diagnosis is often delayed due to the rarity of the disease and the nonspecific nature of presenting symptoms. Case Presentation: This case report describes the complex clinical management of a 9-year-old boy who presented with gradual onset of bone pain and visible deformities of the upper and lower extremities, which prompted further evaluation and later led to a diagnosis of hyperparathyroidism secondary to a parathyroid adenoma. The diagnosis was confirmed by elevated parathyroid hormone levels, hypercalcemia, and imaging studies revealing a parathyroid adenoma. Despite a comprehensive preoperative planning and surgical intervention, adenoma resection was not successful during the first two surgeries, leading to persistent hyperparathyroidism and subsequent surgical complications such as postoperative thyroid tissue damage and resultant iatrogenic hypothyroidism. Ultimately, the third surgical attempt successfully removed the adenoma, leading to a marked resolution of hyperparathyroidism and gradual return to normal calcium and parathyroid hormone levels. The patient’s bone pain and deformities showed improvement during follow-up. Conclusion: This case highlights the numerous challenges in managing hyperparathyroidism in pediatric patients. In particular, it illustrates the potential complications that can arise when the disease is resistant to initial treatment efforts. This report underscores the importance of having a multidisciplinary approach, carefully planned and executed surgical intervention and vigilant postoperative care in pediatric patients with hyperparathyroidism. Early recognition, accurate localization of the adenoma, and coordination among specialists are essential for favorable outcomes in complex pediatric cases such as this. Continued follow-up is essential to monitor for recurrence and to manage any long-term complications. Copyright © 2025 Tavakolizadeh et al. Published by Tehran University of Medical Sciences. This work is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited.