Elevation of Parathyroid Hormone Levels after Surgery in Childhood-onset Primary Hyperparathyroidism : A Case of an 11-year-old Boy

Primary hyperparathyroidism (PHPT) is rare in children. The endocrinological management after parathyroidectomy in children is not well established. The patient reported here was an 11-year-old boy who underwent parathyroidectomy for PHPT. He started taking calcium lactate hydrate and alfacalcidol 6 days after surgery to prevent postoperative hypocalcemia. His intact parathyroid hormone (PTH) level subsequently increased over the 2 months after surgery, while his serum calcium levels were stable. Although we were concerned about recurrence, his intact PTH level subsequently decreased, and his bone mineral density (BMD) improved postoperatively. Three years after parathyroidectomy, his intact PTH level and BMD are normal, and he is growing normally. It was thought that his transient intact PTH elevation had been caused secondarily by insufficient calcium supplementation after surgery, as suggested by low urine calcium levels at that time. Fortunately, in our case, growth and BMD were not affected postoperatively. Nevertheless, in pediatric cases of PHPT, following up the postoperative endocrinological course is thought to be necessary to obtain healthy growth in terms of stature and bone.