Calcaterra Valeria, Pelizzo Gloria, Pipolo Andreana, Montecamozzo Giulio, Fabiano Valentina, Grazi Roberta, Carlucci Patrizia, Zuccotti Gianvincenzo
Pediatric Department, "Vittore Buzzi" Children's Hospital, Milan, Italy.
Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy.
Front Surg. 2022 May 19;9:885188. doi: 10.3389/fsurg.2022.885188. eCollection 2022.
Neuropsychiatric symptoms are rarely described as a manifestation of hyperparathyroidism, especially in children. We describe the case of an adolescent with hypercalcemia related to and hyperfunctioning parathyroid adenoma presenting with acute neuropsychiatric symptoms. A 14-year-old-girl presented into the Emergency Service Department because of an acute onset of marked asthenia, muscle weakness with difficulty in walking, and altered mental status, which included nonsensical speech. No other neurological signs were present. Abdominal, cardiac, and thoracic examination were unremarkable. There was no recent history of trauma or infection. Family history was negative for neurologic disorders. Her past medical history was unremarkable. A head CT scan showed negative results. The laboratory work-up showed elevated levels of calcium level (14.35 mg/dl; nv 9-11 mg/dl), parathyroid hormone (PTH; 184 pg/ml; nv 3.5-36.8 pg/ml), and creatinine (1.23 mg/dl; nv 0.45-0.75 mg/dl). Sodium, potassium, chloride, thyroid function, glycemia, and insulin values were normal. Neck ultrasonography showed a solid, oval, capsulated, hypoechoic neoformation, with discrete vascularization localized to the inferior pole of the right thyroid lobe, referring to parathyroid tissue. Scintigraphy revealed a hyperfunctioning parathyroid tissue at the inferior pole of the right thyroid lobe. Massive intravenous hydration and diuretic therapy were started. The signs and symptoms of hypercalcemia improved after the initiation of therapy. The patient was submitted to right cervicotomy and muscle sparing for the removal of the adenoma of the right superior parathyroid gland. After surgery, a decrease in PTH levels (<4 pg/ml) and calcium levels (9.1 mg/dl) was recorded. During follow-up, calcium values remained stable; a progressive normalization of PTH was obtained. The oral calcium therapy was suspended after 3 months from surgery. No neuropsychiatric symptoms recurred. An evaluation of the serum calcium level is mandatory in children and adolescents with unexplained neurological signs or symptoms, and a check for hyperparathyroidism should be considered.
神经精神症状很少被描述为甲状旁腺功能亢进的表现，尤其是在儿童中。我们描述了一例与甲状旁腺腺瘤功能亢进相关的高钙血症青少年患者，该患者出现急性神经精神症状。一名14岁女孩因急性起病出现明显乏力、肌肉无力伴行走困难以及精神状态改变（包括胡言乱语）而就诊于急诊科。未发现其他神经系统体征。腹部、心脏和胸部检查均无异常。近期无外伤或感染史。家族史中无神经疾病。她既往病史无异常。头颅CT扫描结果为阴性。实验室检查显示钙水平升高（14.35mg/dl；正常范围9 - 11mg/dl）、甲状旁腺激素（PTH；184pg/ml；正常范围3.5 - 36.8pg/ml）和肌酐（1.23mg/dl；正常范围0.45 - 0.75mg/dl）。钠、钾、氯、甲状腺功能、血糖和胰岛素值均正常。颈部超声显示一个实性、椭圆形、有包膜、低回声的新生物，有离散血管化，位于右甲状腺叶下极，提示为甲状旁腺组织。闪烁扫描显示右甲状腺叶下极有功能亢进的甲状旁腺组织。开始进行大量静脉补液和利尿治疗。治疗开始后高钙血症的体征和症状有所改善。患者接受了右侧颈前切开术并保留肌肉以切除右上甲状旁腺腺瘤。术后记录到PTH水平下降（<4pg/ml）和钙水平下降（9.1mg/dl）。在随访期间，钙值保持稳定；PTH逐渐恢复正常。术后3个月停用口服钙剂治疗。未再出现神经精神症状。对于有不明原因神经体征或症状的儿童和青少年，必须评估血清钙水平，应考虑检查是否存在甲状旁腺功能亢进。
