Thyroid Unit, Medical Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Front Endocrinol (Lausanne). 2020 Sep 29;11:581765. doi: 10.3389/fendo.2020.581765. eCollection 2020.
Psychiatric disorders are rare clinical manifestations of hypercalcaemia in the pediatric population, are relatively more frequent during adolescence and are often overlooked in cases of severe hypercalcaemia. We described the case of a 17-year-old girl affected by anorexia nervosa, depression and self-harm with incidental detection of moderate hypercalcaemia. Clinical, laboratory and instrumental tests demonstrated that hypercalcaemia was secondary to primary hyperparathyroidism (PHPT) due to a mediastinal parathyroid adenoma in the thymic parenchyma. After parathyroidectomy with robot-assisted surgery, we observed the restoration of calcium and PTH levels in addition to an improvement in psychiatric symptoms. This case demonstrates that serum calcium concentration should be evaluated in adolescents with neurobehavioural symptoms and in cases of hypercalcaemia PHPT should be excluded. Surgery represents the cornerstone of the management of PHPT and may contribute to improving quality of life and psychological function in these patients. However, the complexity of neurological involvement in cases of hypercalcaemia due to PHPT requires further investigations to establish the real impact of this condition on the neurocognitive sphere.
精神障碍是儿科高钙血症罕见的临床表现，在青春期更为常见，在严重高钙血症的情况下往往被忽视。我们描述了一例 17 岁女孩，患有神经性厌食症、抑郁症和自残行为，偶然发现中度高钙血症。临床、实验室和仪器检查表明，高钙血症继发于甲状旁腺腺瘤位于胸腺实质的原发性甲状旁腺功能亢进症（PHPT）。机器人辅助手术后行甲状旁腺切除术，我们观察到钙和 PTH 水平恢复，以及精神症状改善。该病例表明，青少年出现神经行为症状时应评估血清钙浓度，出现高钙血症时应排除 PHPT。手术是 PHPT 治疗的基石，可改善患者的生活质量和心理功能。然而，由于 PHPT 引起的高钙血症对神经认知领域的影响的复杂性需要进一步研究来确定。
