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  Children's Health

July 2009
Parathyroid Adenoma: Curing Childhood Limp
Dr Subrata Dey
 
Even in her wildest imagination, Megha Seehra did not dream that the healing route of her persistent leg pain lay through her neck. This 13-year-old girl from Durgapur, West Bengal, started suffering from persistent pain in her hips and legs since the last few months.
Since the first week of December, her father noticed that her walking posture changed and she was putting more pressure on her left leg. Over the next two days, the pain was so severe that she could barely walk. An MRI at a hospital in Durgapur revealed osteomalacia, a condition where the calcium store of the bones are depleted and the bones are left weak.

Considering the weak condition of her femur bones, Megha was immediately referred to the Centre of Excellence in Orthopaedics at Apollo Gleneagles Hospitals, Kolkata, on Christmas Eve 2008 where she was examined by the consultant orthopaedic surgeon Dr. Tathagata Das.

"Surgical placement of plates and screws would very well strengthen her severely weak neck of femur. However, a more pressing concern was the cause Parathyroid Adenoma: A unique cause of childhood limp of osteomalacia in such a young well nourished girl," remembered Dr Das, consultant paediatric endocrinologist. His preliminary investigations suspected an over activity of the parathyroid glands to be the cause. The Sestamibi Parathyroid Scan confirmed there was an adenoma in the left lower parathyroid gland.

There are four parathyroid glands in everyone, usually located behind the thyroid gland. These glands release the parathyroid hormone which maintains the balance of calcium in the blood by promoting calcium absorption from the intestine and leaching calcium from the bone. Excessive levels of parathyroid hormone causes marked breakdown of bone and elevation of blood calcium levels. Megha was found to have very high levels of parathyroid hormone in the blood produced by the adenoma causing severe depletion of calcium from the bones such that her bones were left fragile. She was diagnosed to have a left lower parathyroid adenoma - an extremely rare condition in childhood - and she had precision surgical removal of the adenoma by consultant onco surgeon Dr. Saikat Gupta.

Once the cause of the calcium depletion from the bone was removed, Megha bounced back fast. She was started on calcium and vitamin D supplements to counter the 'hungry bone syndrome.' "I was unable to walk before but after my surgery, the pain is no more there," chirped Megha, now walking confidently. Her hip x-rays show that her bones have already started to heal up and within a few months, it will be completely normal.

As one of the specialists in the team, I can say that the diagnosis of the problem was the turning point in this case. There are many childhood endocrinal disorders like this, which present with a wide range of symptoms. Once the diagnosis is established, most of these conditions can be cured, enabling the child to grow up healthy.
Dr Subrata Dey Consultant Pediatric Endocrinologist at Apollo Gleneagles Hospitals, Kolkata

    
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