Eze Ujunwa Justina, Elfadil Sundus
Family Medicine Residency Program, WellSpan Good Samaritan Hospital, Lebanon, PA, USA.
Pediatric Medicine Clinic, WellSpan Pediatric Medicine - Cornwall Road, Lebanon, PA, USA.
SAGE Open Med Case Rep. 2024 Mar 25;12:2050313X241241439. doi: 10.1177/2050313X241241439. eCollection 2024.
Primary hyperparathyroidism is rare in children and usually presents with nonspecific symptoms. Ramadan fasting has been reported to unmask the diagnosis of primary hyperparathyroidism. A 15-year-old boy presented to the clinic for an emergency department follow up visit. He had started Ramadan fasting a week before his presentation to the clinic. He reported unintentional weight loss, abdominal pain, constipation, frequent headaches, exercise intolerance, tiredness, and palpitations. Physical examination was unremarkable except that he looked tired. Investigations revealed elevated calcium and parathyroid hormone, hypophosphatemia, low vitamin D, and parathyroid adenoma. He underwent parathyroidectomy, leading to a decrease in parathyroid hormone levels. He did well postoperatively, and by his 11-month follow-up visit, his calcium was back to a normal level, he was energetic, and had gained weight. A high index of suspicion is required to diagnose primary hyperparathyroidism in young patients, especially young Ramadan-fasting patients, who mostly present with vague nonspecific symptoms.
原发性甲状旁腺功能亢进症在儿童中较为罕见，通常表现为非特异性症状。据报道，斋月禁食可使原发性甲状旁腺功能亢进症的诊断得以显现。一名15岁男孩到诊所进行急诊科随访。他在到诊所就诊前一周开始斋月禁食。他报告称有非故意体重减轻、腹痛、便秘、频繁头痛、运动不耐受、疲倦和心悸。体格检查无异常，只是他看起来很疲倦。检查发现血钙和甲状旁腺激素升高、低磷血症、维生素D水平低以及甲状旁腺腺瘤。他接受了甲状旁腺切除术，导致甲状旁腺激素水平下降。他术后恢复良好，在11个月的随访时，血钙恢复正常，精力充沛，体重增加。对于年轻患者，尤其是斋月禁食的年轻患者，诊断原发性甲状旁腺功能亢进症需要高度的怀疑指数，因为这些患者大多表现为模糊的非特异性症状。
