Summary
Parathyroid surgery in children is uncommon. Spontaneously occurring cases of hyperparathyroidism are almost always due to single-gland disease; however, on exploration all four parathyroid glands should be identified. Most of the other instances in which the surgeon needs to perform a parathyroidectomy on an infant or a child will be situations were multiple-gland disease is the rule rather than the exception. Therefore, the surgeon must have in his mind a well developed logical approach to the management of children with parathyroid disorders on the basis of multiple glandular disease. We believe that the technique of parathyroid autotransplantation very satisfactorily addresses the surgical needs of children with familial hyperparathyroid states, including the multiple endocrine neoplasias. We believe that it is mandatory treatment in patients presenting with neonatal primary hyperparathyroidism and is also the procedure of choice in children with secondary and tertiary hyperparathyroidism. The workup and diagnosis of parathyroid disorders should be familiar to the surgeon who undertakes neck exploration on children, and the entity of familial hypocalciuric hypercalcemia should be looked for, as these patients have a strong likelihood of not benefiting from parathyroidectomy.
Zusammenfassung
Operationen der Nebenschilddrüse bei Kindern sind selten. Spontan auftretende Fälle von Hyperparathyreoidismus beruhen fast immer auf der Erkrankung einer einzelnen Drüse. Es sollten jedoch bei der Operation alle 4 Nebenschilddrüsenkörperchen identifiziert werden. Bei den meisten anderen Fällen, wo der Chirurg bei Säuglingen oder Kindern eine Parathyroidektomie durchführen muß, liegt in der Regel eine Erkrankung mehrerer Drüsen anstatt nur einer vor. Daher muß der Chirurg ein klares Konzept der Behandlung von Kindern mit Erkrankungen mehrerer Nebenschilddrüsenkörperchen haben. Es wird die Auffassung vertreten, daß die Technik der Nebenschilddrüsenautotransplantation den chirurgischen Erfordernissen bei Kindern mit familiärem Hyperparathyreoidismus inklusive der multiplen endokrinen Neoplasien entspricht. Diese Technik ist ebenfalls die Methode der Wahl bei Patienten mit neonatalem Hyperparathyreoidismus sowie bei Kindern mit sekundärem und tertiärem Hyperparathyreoidismus. Der Chirurg, der Explorationen der Halsregion vornimmt, sollte mit der Diagnostik von Nebenschilddrüsenerkrankungen vertraut sein. Es soll auf das Krankheitsbild der familiären hypokalziurischen Hyperkalziämie geachtet werden, da diese Patienten höchstwahrscheinlich von einer Parathyroidektomie nicht profitieren werden.
Résumé
L’ablation chirurgicale des glandes parathyroïdes chez les enfants est rare. Les cas d’hyperpara-thyroïdie survenue spontanément sont presque toujours dus à une affection d’une seule glande; il faudra malgré tout toujours vérifier les quatre glandes. Dans la plupart des cas pout lesquels une parathyroïdectomie s’impose, il y a affection multiple des glandes. Il faut donc que le chirurgien ait mis en place un plan thérapeutique logique pour le traitement des enfants présentant des troubles parathyroïdien dus à des affections glandulaires multiples. A notre avis, la technique d’autotransplantation parathyroïdienne répond parfaitement aux besoins des enfants de familles où les cas d’hyperparathyroïdie sont fréquents, y compris les néoplasies endocrines multiples. Pour nons ce traitement s’impose absolument dans le cas de patients présentant une hyperpara-thyroïdie néonatale primaire et reste aussi le traitement de choix des hyperparathyroïdies secondaires et tertiaires. Le chirurgien se doit de connaître parfaitement la méthode de diagnostic des troubles parathyroïdiens quand il examine le cou des enfants et de prendre en considération une possibilité d’hypercalcémie hypocalciurique familiale qui risquerait fort de compromettre les résultats de la parathyroïdectomie.
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© 1991 Springer-Verlag Berlin Heidelberg
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Ross, A.J. (1991). Parathyroid Surgery in Children. In: Gauderer, M.W.L., Angerpointner, T.A. (eds) Surgery for Endocrinological Diseases and Malformations in Childhood. Progress in Pediatric Surgery, vol 26. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-88324-8_7
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DOI: https://doi.org/10.1007/978-3-642-88324-8_7
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