Hyperparathyroidism in Children

What is hyperparathyroidism in children?

Hyperparathyroidism is when the parathyroid glands make too much parathyroid hormone. The condition is rare in children.

The parathyroid glands are 4 tiny glands located on the back of the thyroid. The hormone they make helps manage levels of calcium in the bloodstream. High levels of the hormone lead to high levels of calcium. This occurs because bone breaks down and releases calcium, and the kidneys and the intestines increase their calcium absorption. Minerals from the bone are released into the blood also causing high levels of calcium.. This process can cause thinning bones (osteoporosis). High calcium levels also increase the risk of crystallization with phosphate, which results in kidney stones. Kidney stones are hard mineral crystals that get stuck in the urinary system.

What causes hyperparathyroidism in a child?

Causes can include:

• Tumors on the parathyroid glands that aren’t cancer (benign)

• Enlargement of the parathyroid glands (usually all 4 of them)

• Vitamin D deficiency (secondary hyperparathyroidism)

• Chronic kidney disease

The condition in children is more often part of a syndrome, such as multiple endocrine neoplasia. 

Which children are at risk for hyperparathyroidism?

A child is at risk for hyperparathyroidism if they have any of these:

• Tumors on the parathyroid glands that aren’t cancer (benign)

• Enlargement of the parathyroid glands

• Multiple endocrine neoplasia (endocrine syndrome)

What are symptoms of hyperparathyroidism in a child?

Some children do not have symptoms. If symptoms occur, they can be a bit different in each child. Symptoms are mainly cause by hypercalcemia and they can include:

• Kidney pain, from kidney stones

• Bone pain, from thinning bones

• Joint aches and pains

• Belly (abdominal) pain

• Nausea

• Vomiting

• Tiredness

• Urinating a lot

• Thirst

• Confusion

• Muscle weakness

• Broken bones

• Weight loss

• Diarrhea

• Constipation

• Depression

• Headache

The symptoms of hyperparathyroidism can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

How is hyperparathyroidism diagnosed in a child?

The condition can be hard to diagnose. The healthcare provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. Your child will have a physical exam and tests, such as:

• Blood tests. These are done to measure calcium, phosphorus, magnesium, and hormone levels in the blood. The first sign of a parathyroid condition may be a higher-than-normal level on a calcium blood test.

• X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the bones to check for thinning.

• Genetic testing. Your child may need this test if hyperparathyroidism or other related hormone conditions run in the family.

• Ultrasound (sonography). This test uses sound waves and a computer to create images of blood vessels, tissues, and organs. This may be done to look at the parathyroid gland.

• Nuclear medicine test. This type of test uses small amounts of radioactive material to create images of the inside of the body. A test that adds radioactive material to a protein called sestamibi may be done. This material is picked up by the overactive parathyroid and helps tell the difference between an overactive parathyroid and a normal gland.

• CT scan. This test uses a series of X-rays and a computer to make detailed images of the body. A CT scan can show bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.

• MRI. This test uses large magnets and a computer to make detailed images of tissues in the body.

How is hyperparathyroidism treated in a child?

Your child's healthcare provider will consider your child's age, overall health, and other factors when advising treatment. Your child may need to see a pediatric endocrinologist. This is a healthcare provider with extra training in treating children with hormone problems. Treatment usually includes surgery. This is done to remove some or all of the parathyroid glands.

What are possible complications of hyperparathyroidism in a child?

If untreated, the condition can lead to serious complications, including:

• Thin bones (osteoporosis or osteopenia)

• Broken bones

• Other bone problems

• Kidney stones

• Kidney disease

• Inflammation of the pancreas (pancreatitis)

• High blood pressure

• Heart problems including arrhythmias

• Enlarged ventricles in the heart

• Heart valve damage

• Depression

• Memory problems 

How can I help my child live with hyperparathyroidism?

A child will need specialty care by a healthcare team. Even after surgery, a child may need lifelong checking for symptoms of high calcium levels in the blood. Work with your child's healthcare providers to create an ongoing plan to manage your child’s condition.

When should I call my child's healthcare provider?

Call your child’s healthcare provider if your child has symptoms of hyperparathyroidism. If your child has been diagnosed with the condition, call the healthcare provider if your child has:

• Symptoms that don’t go away after treatment

• Symptoms that come back after treatment

• New symptoms

Key points about hyperparathyroidism in children

• Hyperparathyroidism is when the parathyroid glands make too much parathyroid hormone.

• The hormone helps manage levels of calcium in the bloodstream. High levels of the hormone lead to high levels of calcium.

• The condition can cause thinning bones (osteoporosis) and kidney stones.

• Symptoms can include bone pain, belly pain, kidney pain, and joint aches.

• Your child may have blood tests and imaging tests.

• Treatment usually includes surgery. This is done to remove some or all of the parathyroid glands.

• Even after surgery, a child may need lifelong checking for symptoms of high calcium levels in the blood.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new directions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.