Bone Abstracts

Background: Recurrent abdominal pain is common in children and adolescents. This symptom could be raised by the complex of both functional and organic etiologies.

Presenting problem: We put forward a seventeen-years-old adolescent girl with personal history of repeated abdominal pain and urinary tract infections. Her family history was negative.

Clinical management: Our patient was admitted to hospital due to recurrent abdominal pain and third manifestation of pyelonephritis (11/2017, 1/2018, 10/2018). Cultivation reported on a significant bacteriuria - E.coli 106. She suffered from right side backache at the time of admission. The ultrasound examination revealed the presence of 4 mm stone in the upper calyx of the right kidney. Metabolic investigation showed hypercalcemia, hypercalciuria, and inappropriately elevated serum parathyroid hormone level. Blood levels of other minerals as well as alkaline phosphatase activity were in normal range. Control renal ultrasound six weeks later detected hyperechoic deposit (13 mm) in cranial part of the right kidney and calculus (8 mm) in the upper calyx of the left kidney. Cervical ultrasonography described parathyroid glands with normal appearence. Parathyroid scintigraphy with MIBI scan by SPECT/CT revealed MIBI accumulation in the lover pole of the right thyroid gland lobe, persistent on the late scan. This finding corresponded to adenoma or parathyroid gland hyperplasia. Surgery was performed and suspected parathyroid gland was removed with significant intraoperative decrease of serum parathormone concentration (from 22.73 to 2.45 pmol/l). At follow-up examination two weeks later total plasma calcium, ionized calcium, and parathormone levels remained within normal range. Histopathological examination confirmed the diagnosis of parathyroid adenoma.

Discussion: Primary hyperparathyroidism is ranked among most common endocrine diseases, affecting predominantly postmenopausal women. In children and adolescents, urolithiasis and primary hyperparathyroidism is a rare condition. It is mostly caused by adenoma of parathyroid gland. The possibility of primary hyperparathyroidism should be included in the differential diagnosis in case of repeated pyelonephritis, abdominal pain and nephrolithiasis in a pediatric patient.

Disclosure: The authors declared no competing interests.