Atypical parathyroid tumor: a rare cause of primary hyperparathyroidism in an adolescent

Hyperparathyroidism is a rare entity in pediatrics. It is defined as increased production of parathyroid hormone and may be due to a primary defect of the parathyroid glands, primary hyperparathyroidism, or to compensatory parathyroid hormone production to correct hypocalcemic states of various origin, secondary hyperparathyroidism. We describe the case of a 15-year-old adolescent girl with a history of several months of deteriorating school performance, anxiety crises, weight loss and tachycardia. Laboratory findings revealed hypercalcemia, hypophosphatemia, elevated parathyroid hormone, and hypovitaminosis D. Imaging studies revealed widespread bone involvement and parathyroid nodular formation. A parathyroidectomy and right hemithyroidectomy were performed, after which the patient presented with persistent hungry bone syndrome. The pathological diagnosis was atypical parathyroid tumor. We describe the presentation, the results of the various complementary tests performed, and the short- and long-term outcome.