Hiperkalseminin nadir bir nedeni: paratiroid adenomu olan iki olgu
Hiperkalsemi, uç organ hasarına yol açabilen nadir fakat ciddi bir metabolik bozukluktur. Primer hiperparatiroidizm, çocuklarda ve ergenlerde nadir görülür ve en sık nedeni paratiroid adenomudur. Hastaların çoğu klinik olarak hiperkalsemi semptomlarını gösterirler. Bu bildirinin amacı, farklı klinik bulgularla ortaya çıkan ve nadir görülen iki ayrı paratiroid adenomu olgusunu tanımlamaktır. Karın ağrısı, kusma ve bulantı şikayeti ile başvuran 14 yaşında erkek hastaya amilaz ve lipaz seviyelerinin yüksek olması üzerine akut pankreatit tanısı kondu. Bu duruma ek olarak hiperglisemi ve hiperkalsemisi saptanan hastanın PTH değeri oldukça yüksekti. Paratiroid sintigrafisi çekilerek paratiroid adenomu gösterildi. Hastaya pamidronat verilerek normokalsemi sağlandı ve hiperglisemi için insülin tedavisi başlandı. Replasman tedavisi ile akut pankreatit düzeldikten sonra adenom eksizyonu yapıldı. Hastanın posoperatif dönemde aç kemik sendromu gelişti ve tedavi edildi. İzlemde hastanın insülin tedavisine devam edildi. İkinci olgu bulantı, iştahsızlık, halsizlik ve kabızlık şikayetleri ile başvuran 12 yaşında erkek hasta idi. Bakılan laboratuar parametrelerinde hiperkalsemi, hipofosfatemi ve hiperparatiroidi saptandı. Paratiroid sintigrafisi ile paratiroid adenomu tespit edildi. Adenom eksizyonu yapıldı ve postoperatif döenmde aç kemik sendromu gelişti. Primer hiperparatiroidizm ile ilişkili hiperkalsemi nadir olmakla birlikte çocuklarda ve ergenlerde genellikle semptomatiktir. Hastaları komplikasyonlardan ve kalıcı hasarlardan korumak için hiperkalseminin ayırıcı tanısında akılda tutulmalıdır.
A rare cause of hypercalcemia: two cases of parathyroid adenoma
Hypercalcemia is a rare but serious metabolic condition that may lead to end-organ damage. Primary hyperparathyroidism is a rare disease in children and adolescents and parathyroid adenoma is the most common cause. Most of patients are clinically symptomatic and may present signs or symptoms of hypercalcemia. The aim of this report is to describe two case of hypercalcemia due to parathyroid adenoma presenting with different clinical findings. 14 years old male patient with abdominal pain, vomiting and nausea were diagnosed with acute pancreatitis. His laboratory findings were elevated amylase and lipase levels, hyperglycemia, hypercalcemia and hyperparathyroidism. Parathyroid scintigraphy showed the presence of an adenoma. Normocalcemia was provided with pamidronate and hyperglycemia was treated with insulin. Adenoma excision was performed after acute pancreatitis was recovered with replacement therapy. After the surgery, diabetes mellitus persisted and he had a hungry bone syndrome. Other patient was a 12-year-old male patient presented with complaints of anorexia, weakness, constipation and nausea. He had hypercalcemia, hypophosphatemia and hyperparathyroidism. Parathyroid adenoma was detected with parathyroid scintigraphy. Adenoma excision was performed and postoperatively he had a hungry bone syndrome. Hypercalcemia associated with primary hyperparathyroidism is rare but generally symptomatic in children and adolescents. It should be kept in mind in the differential diagnosis of hypercalcemia and patients should be protected from complications and permanent damage.
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