Focused image-guided parathyroidectomy in the current management of primary hyperparathyroidism

ObjectivePrimary hyperparathyroidism (PHPT) in childhood and adolescence has been considered a different disease to that seen in adults, with predominantly familial aetiology mandating open exploration to exclude parathyroid hyperplasia in contrast to the adoption of focused image-guided parathyroidectomy (FP) in adults.Study designA retrospective cohort study in a tertiary referral hospital setting of all children and adolescents (<18 years) undergoing parathyroid surgery for PHPT. Data were obtained from a dedicated endocrine surgery database and hospital medical records.ResultsOver the 35-year study period (1980–2014), there were 31 patients who underwent parathyroidectomy for PHPT. 3 patients were from known multiple endocrine neoplasia type 1 syndrome (MEN1) families, 3 had an isolated family history of PHPT and 25 were sporadic. In the sporadic group, 24 (96%) presented with symptomatic hypercalcaemia, affecting the gastrointestinal, musculoskeletal, genitourinary or neuropsychiatric systems. In the 25 patients with sporadic PHPT, nine (36%) had FP with a single adenoma removed with a 100% initial cure rate. Sixteen patients (64%) in the sporadic group had an open exploration: 14 had single gland disease while 2 patients required a second procedure to achieve a final cure rate of 100%. Of the three patients with MEN1, one was cured, one has persistent hyperparathyroidism after FP and the third has permanent hypoparathyroidism after open exploration.ConclusionsThe majority of children and adolescents with PHPT have symptomatic disease due to a single adenoma. They can therefore be managed in a similar fashion to their adult counterparts with preoperative localisation studies aiming to permit FP in a day case setting.

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Presenting features and molecular genetics of primary hyperparathyroidism in the paediatric population

Acta Endocrinologica ◽

10.1530/eje-20-1119 ◽

2020 ◽

Author(s):

Yasmine El Allali ◽

Coralie Hermetet ◽

Justine Bacchetta ◽

Cyril Amouroux ◽

Anya Rothenbuhler ◽

...

Keyword(s):

Cell Proliferation ◽

Primary Hyperparathyroidism ◽

Children And Adolescents ◽

Molecular Genetics ◽

Paediatric Population ◽

Urinary Calcium ◽

Childhood And Adolescence ◽

Parathyroid Cell ◽

Older Children ◽

Serum Pth

Aim: To describe the presenting features and molecular genetics of primary hyperparathyroidism (PHPT) in the paediatric population. Methods: Retrospective study of 63 children diagnosed with primary PHPT from 1998 to 2018. Results: Compared to older children, infants were often asymptomatic (54 vs. 15%, p = 0.002) with a milder form of PHPT. When symptomatic, children and adolescents mostly presented with non-specific complaints such as asthenia, depression, weight loss, vomiting or abdominal pain. A genetic cause of PHPT was identified in about half of this cohort (52%). The infancy period was almost exclusively associated with mutation in genes involved in the calcium-sensing receptor (CaSR) signalling pathway (i.e. CaSR and AP2S1 genes, ‘CaSR group’; 94% of mutated infants) whereas childhood and adolescence were associated with mutation in genes involved in parathyroid cell proliferation (i.e. MEN1, CDC73, CDKN1B and RET genes, ‘cell proliferation group’; 69% of mutated children and adolescents). Although serum calcium levels did not differ between the 2 groups (p = 0.785), serum PTH levels and the urinary calcium/creatinine ratio were significantly higher in ‘cell proliferation group’ patients compared to those in the ‘CaSR group’ (p = 0.001 and 0.028, respectively). Conclusion: Although far less common than in adults, PHPT can develop in children and is associated with significant morbidity. Consequently, this diagnosis should be considered in children with non-specific complaints and lead to monitoring of mineral homeostasis parameters. A genetic cause of PHPT can be identified in about half of these patients.

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99mTechnetium Sestamibi-123Iodine Scintigraphy Is More Accurate Than 99mTechnetium Sestamibi Alone before Surgery for Primary Hyperparathyroidism

International Journal of Molecular Imaging ◽

10.1155/2015/391625 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Eeva M. Ryhänen ◽

Jukka Schildt ◽

Ilkka Heiskanen ◽

Mika Väisänen ◽

Aapo Ahonen ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Serum Calcium ◽

Multiglandular Disease ◽

Single Adenoma ◽

Histological Findings ◽

Cure Rate ◽

Single Centre ◽

Primary Surgery ◽

Outcome Of Surgery ◽

Dual Tracer

Objectives. Studies comparing outcome of single-T99mc-methoxyisobutylisonitrile (T99mc-sestamibi) and dual-tracer T99mc-sestamibi scintigraphy in combination with 123I before primary surgery of primary hyperparathyroidism (PHPT) are scarce. Methods. We compared T99mc-sestamibi/123I and T99mc-sestamibi in a single-centre retrospective series of 269 PHPT patients. The results were related to laboratory, surgical and histological findings. Results. T99mc-sestamibi/123I and T99mc-sestamibi were positive in 206 (76.6%) and 111 (41.3%) of 269 patients, respectively (P < 0.001). Accuracies for T99mc-sestamibi/123I and T99mc-sestamibi were 63.4% and 34.9%, respectively (96% CI, P < 0.001). Prevalence of multiglandular disease was 15.2%. In multiglandular disease, T99mc-sestamibi/123I and T99mc-sestamibi revealed 43.8 and 22.1% of pathological glands, respectively (P < 0.001). Cure rate was similar for patients with (191/206; 92.7%) and without (59 of 63; 93.7%) a positive T99mc-sestamibi/123I finding. Duration of targeted surgery (one or two quadrants) was 21 and 15 minutes shorter than bilateral neck exploration, respectively (both P < 0.001). Higher serum calcium (P = 0.014) and PTH (P = 0.055) concentrations and larger tumours (P < 0.001) characterized the 206 patients with a positive preoperative scan who were cured by removal of a single adenoma. Conclusions. T99mc-sestamibi/123I scintigraphy is more accurate than T99mc-sestamibi before surgery of PHPT. However, outcome of surgery is not determined by scintigraphy alone.

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A Comprehensive, Multidisciplinary, Personalized, Lifestyle Intervention Program is Associated with Increased Leukocyte Telomere Length in Children and Adolescents with Overweight and Obesity

Nutrients ◽

10.3390/nu13082682 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2682

Author(s):

George Paltoglou ◽

Christina Raftopoulou ◽

Nicolas C. Nicolaides ◽

Sofia M. Genitsaridi ◽

Sofia I. Karampatsou ◽

...

Keyword(s):

Children And Adolescents ◽

Telomere Length ◽

Lifestyle Intervention ◽

Intervention Program ◽

Overweight And Obesity ◽

Initial Assessment ◽

Biological Aging ◽

Childhood And Adolescence ◽

Lifestyle Interventions ◽

Lifestyle Intervention Program

Leucocyte telomere length (LTL) is a robust marker of biological aging and is associated with obesity and cardiometabolic risk factors in childhood and adolescence. We investigated the effect of a structured, comprehensive, multidisciplinary, personalized, lifestyle intervention program of healthy diet and physical exercise on LTL in 508 children and adolescents (239 males, 269 females; 282 prepubertal, 226 pubertal), aged 10.14 ± 0.13 years. Participants were classified as obese (n = 267, 52.6%), overweight (n = 174, 34.2%), or of normal BMI (n = 67, 13.2%) according to the International Obesity Task Force (IOTF) cutoff points and were studied prospectively for one year. We demonstrated that LTL increased significantly after 1 year of the lifestyle interventions, irrespective of gender, pubertal status, or body mass index (BMI). Waist circumference was the best negative predictor of LTL at initial assessment. The implementation of the lifestyle interventions also resulted in a significant improvement in clinical (BMI, BMI z-score and waist to height ratio) and body composition indices of obesity, inflammatory markers, hepatic enzymes, glycated hemoglobin (HbA1C), quantitative insulin sensitivity check index (QUICKI), and lipid profile in all participants. These findings indicate that the increased LTL may be associated with a more favorable metabolic profile and decreased morbidity later in life.

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Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18157739 ◽

2021 ◽

Vol 18 (15) ◽

pp. 7739

Author(s):

Miriam Blume ◽

Petra Rattay ◽

Stephanie Hoffmann ◽

Jacob Spallek ◽

Lydia Sander ◽

...

Keyword(s):

Mental Health ◽

Children And Adolescents ◽

Health Inequalities ◽

Scoping Review ◽

The United States ◽

Family Characteristics ◽

Future Research ◽

Childhood And Adolescence ◽

Moderating Effects ◽

Scoping Reviews

This scoping review systematically mapped evidence of the mediating and moderating effects of family characteristics on health inequalities in school-aged children and adolescents (6–18 years) in countries with developed economies in Europe and North America. We conducted a systematic scoping review following the PRISMA extension for Scoping Reviews recommendations. We searched the PubMed, PsycINFO and Scopus databases. Two reviewers independently screened titles, abstracts and full texts. Evidence was synthesized narratively. Of the 12,403 records initially identified, 50 articles were included in the synthesis. The included studies were conducted in the United States (n = 27), Europe (n = 18), Canada (n = 3), or in multiple countries combined (n = 2). We found that mental health was the most frequently assessed health outcome. The included studies reported that different family characteristics mediated or moderated health inequalities. Parental mental health, parenting practices, and parent-child-relationships were most frequently examined, and were found to be important mediating or moderating factors. In addition, family conflict and distress were relevant family characteristics. Future research should integrate additional health outcomes besides mental health, and attempt to integrate the complexity of families. The family characteristics identified in this review represent potential starting points for reducing health inequalities in childhood and adolescence.

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Probability assessment of facial nerve injury in children and adolescents during the elective maxillofacial surgery

Стоматология детского возраста и профилактика ◽

10.33925/1683-3031-2021-21-1-32-34 ◽

2021 ◽

Vol 21 (1) ◽

pp. 32-34

Author(s):

O. Z. Topolnitsky ◽

E. D. Askerov

Keyword(s):

Facial Nerve ◽

Children And Adolescents ◽

Nerve Injury ◽

Maxillofacial Surgery ◽

Childhood And Adolescence ◽

Legal Problem ◽

Facial Nerve Injury ◽

Risk Of Injury ◽

Complex Anatomy ◽

Clinical Center

Relevance. Various factors can cause facial neuropathy. Iatrogenic facial nerve injury in childhood and adolescence is a complicated medical, psychological and legal problem. Risk assessment of the facial nerve injury during the elective maxillofacial surgeries is required depending on the localization of the procedure. The statistical assessment is very important for the evaluation of the possible iatrogenic facial neuropathy in children and adolescents during the elective maxillofacial surgeries.Materials and methods. 715 medical records for 2017 from the Department of Pediatric Maxillofacial Surgery of the MSUMD Clinical Center for Maxillofacial, Reconstructive and Plastic Surgery were analyzed.Results. There was a risk of injury to the trunk or branches of the facial nerve during surgery in 121 cases (16,9%) for the technical complexity of the surgical approach and the pathology location.Conclusions. There is a high risk of the facial nerve injury during the elective maxillofacial surgery in children and adolescents due to the complex anatomy of the area. Intraoperative neuromonitoring is recommended to prevent iatrogenic neuropathy of the facial nerve.

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Psychosocial Risks of Chronic Health Conditions in Childhood and Adolescence

PEDIATRICS ◽

10.1542/peds.92.6.876 ◽

1993 ◽

Vol 92 (6) ◽

pp. 876-878 ◽

Cited By ~ 1

Author(s):

Keyword(s):

Children And Adolescents ◽

Health Condition ◽

Work And Family ◽

Chronic Health Conditions ◽

Health Conditions ◽

Medical Attention ◽

Childhood And Adolescence ◽

Chronic Health ◽

Persistent Symptoms ◽

The Impact

Chronic health conditions affect many children and adolescents. These conditions are illnesses or impairments that are expected to last for an extended period of time and require medical attention and care that is above and beyond what would normally be expected for a child or adolescent of the same age, extensive hospitalization, or in-home health services.1 These conditions include, among others, juvenile rheumatoid arthritis, asthma, cystic fibrosis, diabetes, spina bifida, hemophilia, seizure disorders, neuromuscular disease, acquired immunodeficiency syndrome, and congenital heart diseases. Although each specific condition may be relatively or extremely rare, when they are considered together, many children and adolescents are affected. Health conditions may be characterized by their duration and their severity. Although these terms are often linked, they refer to different aspects of a health condition. A chronic condition is generally one that has lasted or is expected to last more than a defined period of time, usually 3 months or longer. Conditions vary widely in their onset, course, and duration.2 Severity refers to the impact a condition has on a child's physical, intellectual, psychological, or social functioning.3 This impact may occur as a result of persistent symptoms, required treatments, limitations of activity or mobility, or interference with school, recreation, work, and family activities. Current estimates are that between 10 and 20 million American children and adolescents have some type of chronic health condition or impairment. Most of these conditions are relatively mild and interfere little with the children's ability to participate in usual childhood activities.4 However.

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Die schmerzende Schulter bei Kindern und Jugendlichen im Sport

Sports & Exercise Medicine Switzerland ◽

10.34045/sems/2021/25 ◽

2021 ◽

Keyword(s):

Children And Adolescents ◽

Overuse Injury ◽

Sports Medicine ◽

Traumatic Injury ◽

Pediatric Trauma ◽

Childhood And Adolescence ◽

Adolescent Athletes ◽

Age Appropriate

The shoulder is a particularly vulnerable joint in sports, and especially so in children and adolescents. The normal hypermobility during growth needs to be differentiated from pathological instability. Overuse injury has to be avoided or treated. Some injuries are specific for childhood and adolescence and need to be treated with a specific and age appropriate approach. Traumatic injury is seen as well, but in most cases of more importance for pediatric trauma specialist than sports medicine professionals. This review aims at giving an overview over the most important principles and diagnoses in dealing with sports related shoulder problems in pediatric and adolescent athletes.

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Depressive Illnesses in Children and Adolescents: A Review of Current Concepts

The Canadian Journal of Psychiatry ◽

10.1177/070674378503000208 ◽

1985 ◽

Vol 30 (2) ◽

pp. 119-129 ◽

Cited By ~ 12

Author(s):

B.J. Mcconville ◽

R.T. Bruce

Keyword(s):

Children And Adolescents ◽

Current Knowledge ◽

Considerable Progress ◽

Childhood And Adolescence ◽

Age Related ◽

Developmental Age ◽

The Subject ◽

Made In

Considerable progress has been made in our understanding of depressive illnesses in childhood and adolescence, especially over the last several years. A number of major books on the subject have now appeared, along with a large number of individual papers. This paper attempts to summarize current knowledge, and indicates developmental, age-related and other issues which still require further study.

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