Vikas Shah MBBS, Presenter: Nothing to Disclose

Marina Easty FRCR, Abstract Co-Author: Nothing to Disclose

Rukshana Shroff, Abstract Co-Author: Nothing to Disclose

Lesley Rees, Abstract Co-Author: Nothing to Disclose

William Van't Hoff, Abstract Co-Author: Nothing to Disclose

Rose Ann Dorothy De Bruyn MBBCh, Abstract Co-Author: Nothing to Disclose

To define the subgroups of children referred for ultrasound (US) and scintigraphic imaging of the parathyroid (PT) glands at a specialist paediatric nephrology centre, and to evaluate the role and contribution of imaging to clinical management.

From 2004-2008, 60 US studies were performed to evaluate the PT glands in children with renal disease and refractory hypercalcaemia. 49 children had US (40 single studies, 7 had 2 studies and 2 children had 3 studies; 27 males; age range 1-18 years, median 13 years). 11 (22%) children subsequently underwent a Tc99m-MIBI study within 6 months. US results were categorized as normal, hyperplastic glands or adenoma; scintigraphy results were categorized as normal or adenoma. The casenotes were reviewed to determine the underlying clinical diagnoses and specific management of hyperparathyroidism (HPT) in these children.

Two distinct groups of children were identified; 26/49 had inherited causes of hypophosphataemic rickets with normal renal function and 23/49 had chronic kidney disease (CKD) with secondary HPT. Overall, US suggested adenoma in 8/49 (16%) children and hyperplastic glands in 9/49 (18%). 6/8 children with adenoma on US and 2/9 with hyperplasia on US underwent a scintigraphy study. Of the 6 cases of US diagnosis of adenoma, 3 had positive scintigraphy. Both children with hyperplasia on US had normal scintigraphy. In the final 3/11 cases, scintigraphy was performed despite normal US because of high clinical suspicion of an adenoma. In 1 of these 3 cases, scintigraphy identified ectopic PT adenomatous tissue in the superior mediastinum. In total, 4/11 cases (36%) had scintigraphic evidence of PT adenoma. 1 child had surgery, the others were managed conservatively.

The consequences of HPT and the ensuing mineral dysregulation include long term cardiovascular and skeletal morbidity. Our data suggests that by detecting hyperplastic, adenomatous or ectopic PT glands, US and scintigraphy allow rationalisation of therapy; new drugs such as calcimimetics suppress PT overactivity to normalise serum calcium, failing which surgery may be considered. Future studies will aim to clarify and refine the diagnostic pathways.

Children with CKD or inherited hypophosphataemic rickets are prone to the debilitating consequences of hypercalcaemia; US and scintigraphy detect PT gland abnormalities and direct further management.

Shah, V, Easty, M, Shroff, R, Rees, L, Van't Hoff, W, De Bruyn, R, Ultrasound and Scintigraphy of the Parathyroid Glands in Children at a Specialist Paediatric Nephrology Centre: A 5-year Experience.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8006642.html