Endocrine Abstracts

Introduction: Primary hyperparathyroidism (HPT) is usually observed in old people. It is very rare in children and young adults. Our aim is to analyze clinical, biological aspects, and outcome in six subjects under 30.

Methods: The six subjects were chosen among 36 people hospitalized for primary HPT from 2009 to 2012. All had clinical examination, routine analyses, biological (blood and urinary calcium and phosphorus, and vitamin D) and hormonal (at least three PTH) assessments. Radiological exploration was based on cervical ultrasound and MIBI scintigraphy. After medical treatment of severe hyper calcaemia, they were all operated on, and followed.

Results: Mean age=24 (18–30). Primary HPT seemed to be sporadic. Our patients suffered mainly from bone disorders (five cases) and from symptoms of severe hyper calcaemia (n=1). Mean calcaemia=131.5 mg/l (85–110 mg/l), mean phosphorus=23.8 mg/l (25–45 mg/l), mean PTH=753.5 pg/ml (16–87 pg/ml). Calcaemia was ≥140 mg/l in two. Ultrasounds and MIBI showed a single parathyroid tumour in all of them. Histological study demonstrated five adenomas and one carcinoma. The tumour size was ≥2 cm in all cases. Research for MEN was negative. Genetic study could not be done for socio-economical problems. Five did not relapse for 1–7 years; however one was lost in sight.

Conclusion: Primary HPT is rare in people under 30. It is more symptomatic and more severe than in elderly, but the outcome seems better even for the case classified as malignant by histology as there is not any relapsing or metastasises for more than 7 years. In this study the single parathyroid lesion seemed to be sporadic as we excluded MEN syndrome, but an isolated familial form is not totally excluded as genetic study could not be done.