Protean Presentations of Parathyroid Adenoma in Childhood -
Primary hyperparathyroidism is rare in children, occurs in 2–5/100,000 children,[1] and may be due to parathyroid adenoma, familial hyperparathyroidism associated with multiple endocrine neoplasia or secondary to malignancy. Primary hyperparathyroidism is known to present with protean manifestations, leading to misdiagnosis in the initial stage of the disease. Adenoma is a benign condition that can be surgically corrected. Nuclear imaging scintigraphy accurately localizes the tumor in 90% of cases and simplifies the surgical management. We encountered two such cases with the parathyroid gland adenomas who presented to us in two different varied presentations, in which preoperative nuclear imaging and intraoperative parathyroid hormone (PTH) assay played a major role. The two different cases also drew us to the important aspect of Hungry bone syndrome (HBS) which was encountered in the postoperative period, in which the role of pediatric endocrinologist is of paramount importance.

Case Reports:
A 12-year-old girl presented with a 2-week history of worsening epigastric pain, vomiting, and fever. She was treated in outside hospital on the lines of gastroenteritis; however, as the vomiting did not subside, she was referred to our hospital for further management. On examination, she was pale with dry mucous membranes. At admission, she had bradycardia (heart rate 68/min) and hypotension (blood pressure 90/60 mm of Hg) with an increased respiratory rate (24/min)....