Neuropsychiatric symptoms are rarely described as a manifestation of
hyperparathyroidism, especially in children. We describe the case of an adolescent with
hypercalcemia related to and hyperfunctioning
parathyroid adenoma presenting with acute neuropsychiatric symptoms. A 14-year-old-girl presented into the Emergency Service Department because of an acute onset of marked
asthenia,
muscle weakness with difficulty in walking, and altered mental status, which included nonsensical speech. No other neurological signs were present. Abdominal, cardiac, and thoracic examination were unremarkable. There was no recent history of
trauma or
infection. Family history was negative for
neurologic disorders. Her past medical history was unremarkable. A head CT scan showed negative results. The laboratory work-up showed elevated levels of
calcium level (14.35 mg/dl; nv 9-11 mg/dl),
parathyroid hormone (PTH; 184 pg/ml; nv 3.5-36.8 pg/ml), and
creatinine (1.23 mg/dl; nv 0.45-0.75 mg/dl).
Sodium,
potassium, chloride, thyroid function, glycemia, and
insulin values were normal. Neck ultrasonography showed a solid, oval, capsulated, hypoechoic neoformation, with discrete vascularization localized to the inferior pole of the right thyroid lobe, referring to parathyroid tissue. Scintigraphy revealed a hyperfunctioning parathyroid tissue at the inferior pole of the right thyroid lobe. Massive intravenous hydration and
diuretic therapy were started. The signs and symptoms of
hypercalcemia improved after the initiation of
therapy. The patient was submitted to right cervicotomy and muscle sparing for the removal of the
adenoma of the right superior parathyroid gland. After surgery, a decrease in PTH levels (<4 pg/ml) and
calcium levels (9.1 mg/dl) was recorded. During follow-up,
calcium values remained stable; a progressive normalization of PTH was obtained. The oral
calcium therapy was suspended after 3 months from surgery. No neuropsychiatric symptoms recurred. An evaluation of the serum
calcium level is mandatory in children and adolescents with unexplained neurological signs or symptoms, and a check for
hyperparathyroidism should be considered.