Abstract
Abstract Introduction: Hypercalcemia due to primary hyperparathyroidism (PHPT) is uncommon in children with an incidence of 2 to 5 in 100,000 children and adolescents. Primary hyperparathyroidism in children has a bimodal distribution that reflects different etiologies in very young and older children. PHPT is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas account for 20% to 22% of primary hyperparathyroidism cases and are rare in children but should be considered in cases that present with hypercalcemia. Patient concerns: We report the case of a 13-year-old girl with PHPT who presented with an unusual presentation of acute pancreatitis and persistent hypercalcemia. Diagnosis: Tc-99m-sestamibi scanning and chest computed tomography scan with contrast showed an anterior mediastinal lesion at the midline embedded into the thymus and was diagnosed as an ectopic anterior mediastinal parathyroid adenoma. Interventions: The genetic test results of whole-exome sequencing were negative. After thoracoscopic and thymus excision, the patient's serum calcium level immediately normalized. Outcomes: Intact parathyroid hormone, serum calcium, and alkaline phosphatase levels returned to normal within two months. Conclusion: PHPT may present with acute pancreatitis, generalized fatigue, and muscle pain as presented in this patient and need a high index of suspicion for early diagnosis. Delayed diagnosis of PHPT can cause end-organ damage; timely diagnosis is especially critical to preserving bone and renal function.
Published Version
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