A 13-year-old male, previously healthy, who presented four consecutive fractures in his right and left thumbs and right and left wrists, respectively, all related to minor trauma.
In 2005 he presented a fracture of the right tibia, and in 2006 he had a new fracture in the same tibia, also in relation to a minor trauma.
In all these opportunities there was radiological evidence of fractures with complete repair after immobilization.
When consulted directly, the mother reported that since 3 years before she had more irritation and easy tiredness.
In February 2007 she presented intense abdominal pain associated with hematuria, diagnosed with renal lithiasis and nephrocalcinosis.
Subsequently, urinary calculi were removed spontaneously.
A study was conducted to investigate hypercalcemia of 12.0 mg/dL (normal value (NPV): 8.5-10.5), and referred to the Hospital Clínico de la Pontificia Universidad Católica de Chile for completion of the study.
She had a history of bilateral inguinal herniorrhaphy, tonsillectomy, and hysterectomy.
His family history included his mother with papillary thyroid cancer, an uncle with sarcoma and an aunt with cervical cancer.
He did not receive any medication until the onset of symptoms.
Physical examination revealed a young man in good general condition with weight of 65 kg, height 172 cm, blood pressure of 62 mm Hg, normal thyroid, normal hair plug and normal penis 118 cm3, normal testicle II.
Biochemical study and bone densitometry are presented in Tables 1 and 2, respectively.
Other studies: urinary calculus consisting of calcium oxalate (90%) and calcium phosphate (10%).
Renal ultrasound: non-obstructive right juxtavesical urolithiasis and signs suggestive of nephrocalcinosis.
Cervical ultrasound: small nodular lesion (7x4 mm) in right infrathyroid situation, with abundant vascular flow inside, compatible with parathyroid adenoma.
Parathyroid cystogram MIBI-SPECT compatible with hyperfunctioning right inferior parathyroid gland.
1.
With the diagnosis of HPT 1, a cervical exploration was performed, and enlarged right inferior parathyroid was researched, which was resected.
Intraoperative PTH monitoring showed a typical evolution of surgical healing of HPT 1o, from baseline PTH (average of 2 samples) of 153 pg/mL to values of 21 and 19.9 pg/mL to 88 min post-thyroid respectively.
The patient was discharged in good condition.
The biopsy reported a 440 mg parathyroid adenoma.
