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Chapter 7: The different forms of primary hyperparathyroidism at different ages of life: Childhood, pregnancy, lactation, old age - 26/02/25

Doi : 10.1016/j.ando.2025.101696 
Madleen Lemaitre a, Clotilde Picart b, Iva Gueorguieva c, Judith Charbit d, Thomas Edouard e, Agnès Linglart f, Dominique Luton g, Philippe Chanson h,
a Service d’endocrinologie, diabétologie, métabolisme, nutrition, hôpital Huriez, institut génomique européen pour le diabète, université de Lille, CHU de Lille, 59000 Lille, France 
b Service de gériatrie, hôpital Ambroise-Paré, AP–HP, Boulogne-Billancourt, France 
c Service de pédiatrie, hôpital Jeanne-de-Flandres, université de Lille, CHU de Lille, 59000 Lille, France 
d Gerontology Department, Broca Hospital, Université Paris-Cité, AP–HP, Paris, France 
e UMR 1301-Inserm 5070-CNRS EFS, unité d’endocrinologie, maladies osseuses et génétique, hôpital des Enfants, institut RESTORE, université Paul-Sabatier, CHU de Toulouse, 31000 Toulouse, France 
f Inserm, Endocrine Physiology and Physiopathology, service d’endocrinologie et de diabétologie pédiatrique, centre de référence des maladies rares du métabolisme du calcium et du phosphate, hôpital Bicêtre, université Paris-Saclay, Assistance publique–Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France 
g Service de gynécologie-obstétrique, hôpital Bicêtre, université Paris-Saclay, Assistance publique–Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France 
h Inserm, Endocrine Physiology and Physiopathology, service d’endocrinologie et des maladies de la reproduction, centre de référence des maladies rares de l’hypophyse HYPO, hôpital Bicêtre, université Paris-Saclay, Assistance publique–Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France 

Corresponding author. Service d’endocrinologie et des maladies de la reproduction, centre de référence des maladies rares de l’hypophyse HYPO, hôpital Bicêtre, université Paris-Saclay, Assistance publique–Hôpitaux de Paris, 94275 Le Kremlin-Bicêtre, France.Inserm, physiologie et physiopathologie endocriniennes, service d’endocrinologie et des maladies de la reproduction, centre de référence des maladies rares de l’hypophyse HYPO, centre de référence des maladies rares du métabolisme phospho-calcique, hôpital Bicêtre, université Paris-Saclay, Assistance publique–Hôpitaux de ParisLe Kremlin-Bicêtre94275France

Abstract

Primary hyperparathyroidism is rare in children. A germline mutation is identified in half of all children with primary hyperparathyroidism (70% of newborns and infants, and 40% of children and adolescents). The clinical manifestations of primary hyperparathyroidism in children are highly variable (often absent in newborns, rather severe and symptomatic in children and adolescents) and depend on the genetic cause, as well as the severity, rapidity of onset and duration of hypercalcemia. Morphological investigation and treatment of children and adolescents follow the same rules as for adults. Surgery must be carried out by a surgeon expert in this pathology in children. Primary hyperparathyroidism is rarely diagnosed during pregnancy. Pregnancy-related changes in phosphocalcic homeostasis can sometimes mask its symptomatology, which explains why it is most often asymptomatic and/or undiagnosed due to low levels of hypercalcemia and/or the attribution of certain symptoms (e.g. vomiting) to pregnancy itself. Maternal-fetal morbidity associated with primary hyperparathyroidism during pregnancy, historically considered significant, is in fact rare and depends on maternal calcium levels. Treatment (conservative or surgical) must be adapted to the term of pregnancy, the severity of symptoms and maternal-fetal risks. Primary hyperparathyroidism is common in the elderly. Although the diagnostic approach is comparable to that in younger patients, some clinical specificities of this population need to be considered. In view of the high prevalence of osteoporotic fractures and their consequences for morbidity and mortality in the elderly, surgery is the preferred option in case of osteoporosis. In 2024, the neuropsychological symptoms and cardiovascular impairment associated with primary hyperparathyroidism do not justify parathyroidectomy. Parathyroidectomy is much less frequent than in the younger population, although it remains the first-line treatment, especially as its safety and efficacy have been widely demonstrated.

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Keywords : Primary hyperparathyroidism, Child, Pregnancy, Lactation, Elderly, Hypercalcemia, Osteoporosis


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Vol 86 - N° 1

Articolo 101696- febbraio 2025 Ritorno al numero
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  • Chapter 6: Syndromic primary hyperparathyroidism
  • Abdallah Al-Salameh, Magalie Haissaguerre, Christophe Tresallet, Paulina Kuczma, Camille Marciniak, Catherine Cardot-Bauters
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  • Chapter 8: Management of aggressive forms of primary HPT: Parathyroid carcinoma and atypical parathyroid tumor
  • Christine Do Cao, Niki Christou, Julien Hadoux, Désirée Deandreis

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