A Case Of Parathyroid Adenoma In Children With Acute Severe Pancreatitis And High Calcium Crisis As The First Case And Literature Review

Objective: To analyze the clinical features of children with parathyroid adenoma with acute severe pancreatitis and high calcium crisis,and to improve the diagnosis and treatment of parathyroid adenoma in children.Methods: A detailed analysis of the clinical manifestations,auxiliary examinations and diagnosis and treatment of children with parathyroid adenoma in children with acute severe pancreatitis and high calcium crisis as the first manifestation in our hospital,and related literature review.Results: The chief complaint was "poor appetite for 2 days,nausea with abdominal pain for 1 day",and combined with the child’s auxiliary examination,considering the presence of "acute severe pancreatitis,left kidney stones,left renal cyst,cholestasis,ascites,pelvic fluid,hyperlactosis,liver damage,myocardial injury,hypercalcemia,hyponatremia,coagulopathy and hypoalbuminemia,etc.After comprehensive treatment such as fasting water,gastrointestinal decompression,anti-infection,acid suppression and pancreatic enzyme,nutritional support,hypoglycemic and fluid replacement,the symptoms of mental,abdominal pain and nausea improved,but hypercalcemia still occurred.The highest count was 4.44mmol/L,and high calcium crisis appeared,giving active rehydration,diuretic,low-dose hormonal therapy,the effect is not ideal,followed by the use of salmon calcitonin,ibandronate combined with calcium reduction,while actively looking for the cause of hypercalcemia,can not be excluded hyperthyroidism and maligant tumors.Multiple levels of parathyroid hormone increased,but thyroid and parathyroid ultrasound,parathyroid gland scans did not suggest abnormalities,gynecological ultrasound,pelvic MRI was observed.,do not consider gynecological tumors,MRCP,brain CT,chest CT did not suggest space-occupying lesions in brain.After the whole hospital consultation,consider the child with long-term caused by pancreatitis,consider the possibility of hyperparathyroidism,re-examine the parathyroid ultrasound,parathyroid hormone test,whether there is ectopic parathyroid gland.Ultrasound and biopsy results suggest parathyroid adenoma.After posterior parathyroid adenoma resection surgery the blood calcium level become normal and parathyroid hormone decreased significantly,but still not restored to normal levels.The extra-hospital regular monitoring of blood calcium,parathyroid hormone,urine calcium / urine creatinine,vitamin AD concentration,bone density etc were viewed regularly.Conclusion:1.Children’s parathyroid adenoma is especially rare in the clinic.When there are gastrointestinal symptoms such as acute pancreatitis,urinary symptoms such as kidney stones and other systemic dysfunction persistent hypercalcemia,consider of parathyroid adenoma may diagnosed with multiple parathyroid ultrasound and parathyroid hormone test.2.The causes of acute pancreatitis in children are mostly infection caused by pancreaticobiliary diseases,systemic diseases,trauma,drug induction,etc,and cases of parathyroid adenoma leading to this disease are rare in clinical practice,we should raise awareness.3.Hypercalcemia and high-calcium crisis are critical,and should be actively treated to identify the cause and treat the primary disease as soon as possible.