Abstract
Abdominal pain is a common symptom in surgical practice. Around 11%-45% of pediatric population present with abdominal pain. In 29%-87.5% of pediatric population diagnosed with primary hyperparathyroidism (PHPT), abdominal pain and other gastrointestinal (GI) symptoms were the presenting complaint. Hyperparathyroidism is a condition characterized by increased parathyroid hormone (PTH) secretion. It usually presents with nonspecific symptoms of fatigue, poor appetite, weight loss, abdominal pain, nausea, emesis, and bone pain.We present a case of a 13-year-old girl who experienced a recurrent abdominal pain associated with nausea and vomiting, which was diagnosed eight months later when her laboratory investigation revealed high amylase, calcium, and PTH, which raised a suspicion of pancreatitis secondary to hyperparathyroidism. Imaging studies showed retrosternal lesion within the thymus gland, most likely a thymic parathyroid adenoma. The patient's symptoms resolved following thoracoscopic thymectomy, which was performed in another center.To assess the relationship between GI symptoms and PHPT, we reviewed 13 articles published between 2007 and 2020 in the English literature which reported 331 cases of primary PHPT and found that GI symptoms are the fourth most common presentation in patients with PHPT. In those patients, the reported incidence of GI symptoms including abdominal pain was 18.67%. Out of the 331 cases included, only one case mimicked our case as abdominal pain was the main presenting symptom.Unexplained recurrent abdominal pain should raise the suspicion for rare causes. Hyperparathyroidism should be included in the differential diagnosis of recurrent abdominal pain.
Highlights
Recurrent abdominal pain is not an uncommon symptom in children and is frequently described as nonspecific [1]
We present a case of a 13-year-old girl who experienced a recurrent abdominal pain associated with nausea and vomiting, which was diagnosed eight months later when her laboratory investigation revealed high amylase, calcium, and parathyroid hormone (PTH), which raised a suspicion of pancreatitis secondary to hyperparathyroidism
Unexplained recurrent abdominal pain should raise the suspicion for rare causes
Summary
Recurrent abdominal pain is not an uncommon symptom in children and is frequently described as nonspecific [1]. We report the case of a 13-year-old girl who was medically and surgically free with an eight months history of vague recurrent attacks of abdominal pain, nausea, vomiting, and migratory joint pain. During her several visits to medical centers, the physical examination was unremarkable, but at her last presentation to a higher medical center her laboratory investigation revealed elevated amylase and lipase indicating. Further laboratory investigation showed high PTH (339.4 pg/mL; normal range: 22-88 pg/mL), total calcium (3.02 mmol/L; normal range: 2.2-2.7 mmol/L), adjusted calcium (2.83 mmol/L; normal range: 2.10-2.55 mmol/L), and total 25-OH vitamin D (35.2 nmol/L; optimal: >75 nmol/L) With this high PTH and calcium level, diagnosis of primary hyperparathyroidism (PHPT) was established. The patient underwent laparoscopic thymectomy in a different center, and the family reported that the symptoms had resolved
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