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Genu valgum and primary hyperparathyroidism in children
Ramkumar S1, Devasenathipathy Kandasamy2, Vijay MK3, Madhavi Tripathi4, Jyotsna VP5
1Senior Resident, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
2Assistant Professor, Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
3Senior Resident, Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
4Assistant Professor, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
5Additional Professor, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi.

doi:10.5348/ijcri-201455-CS-10041

Address correspondence to:
Dr. Viveka P. Jyotsna
Associate Professor, Department of Endocrinology and Metabolism
All India Institute of Medical Sciences
New Delhi-29
India
Phone: 011-26546659, Mob: 9868397604
Fax: 011-26588641
Email: vivekapjyotsna@gmail.com

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How to cite this article
Ramkumar S, Kandasamy D, Vijay MK, Tripathi M, Jyotsna VP. Genu valgum and primary hyperparathyroidism in children. Int J Case Rep Images 2014;5(6):401–407.


Abstract
Introduction: Bony deformity due to primary hyperparathyroidism is a rare entity in children.
Case Series: We describe two children who presented with genu valgum to the Endocrine Department. Ten children with primary hyperparathyroidism presenting with genu valgum have been reported in literature and have been reviewed by us. Biochemical investigations revealed parathyroid hormone dependent hypercalcemia despite a deficiency of vitamin D in both children. A single parathyroid adenoma was identified by ultrasonography and (99m) Tc-sestamibi (MIBI) scan. Both children underwent resection of the solitary parathyroid lesion which was confirmed as adenoma by histopathological examination. All cases reported in literature had solitary parathyroid adenoma and had onset around puberty consistent with our observation that pubertal growth spurt is responsible for the occurrence of genu valgum in children with previously undiagnosed primary hyperparathyroidism.
Conclusion: Genu valgum is a common skeletal deformity in children with primary hyperparathyroidism. Solitary parathyroid adenoma was identified in all reported cases and all underwent parathyroidectomy. Pubertal growth spurt seems to contribute to the occurrence of genu valgum in children with primary hyperparathyroidism.

Keywords: Genu valgum, Hypercalcemia, Hyperparathyroidism, Parathyroid adenoma, Technetium-99m sestamibi


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Author Contributions:
Ramkumar S – Substancial contribution to conception, design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Devasenathipathy Kandasamy – Substancial contribution to conception, design, Acquisition of data, Drafting and revising article critically for important radiology related content, Final approval of the version to be published
Vijay MK – Substancial contribution to conception, design, Acquisition of data, Drafting the article and revising it critically for important Pathology related content, Final approval of the version to be published
Madhavi Tripathi – Substancial contribution to conception, design and acquisition of data, Drafting the article and revising it critically for important nuclear medicine related content, Final approval of the version to be published
Jyotsna VP – Substancial contribution to conception, design and acquisition of data, Drafting the article and revising it critically for important intellectual content, Final approval of the version to be published
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The corresponding author is the guarantor of submission.
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Authors declare no conflict of interest.
Copyright
© 2014 Ramkumar S et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Ramkumar is Consultant Endocrinologist at Apollo Hospitals, Chennai, India. He earned the undergraduate degree MBBS from Thanjavur Medical College, Dr.MGR medical university, Chennai and postgraduate degree MD from Madras Medical College, Dr. MGR medical university, Chennai. He also obtained D.M Endocrinology Degree from All India Institute of Medical Sciences (AIIMS), New Delhi. He has published four research papers in national and international academic journals and authored two books. His research interests include pediatric endocrinology, pubertal disorders, disorders of sexual differentiation and pituitary disorders



Madhavi Tripathi is Assistant Professor at the Department of Nuclear Medicine and PET, All India Institute of Medical Sciences, New Delhi. She earned the undergraduate degree MBBS from MKCG Medical College, Berhampur and postgraduate degree (MD) from SGPGIMS, Lucknow, India and a DNB in Nuclear Medicine from NBE, Delhi. She has published 45 research papers in national and international academic journals. Her research interests include functional imaging in movement disorders and dementia and use of non-FDG PET tracers in medicine. She intends to pursue a PhD degree in future.



Vijay Maneesh is Senior Resident at Department of Pathology, All India Institute of Medical Sciences, New Delhi. He earned the undergraduate degree MBBS from S.M.S medical college, Jaipur and postgraduate degree MD Pathology from All India Institute of Medical Sciences, New Delhi. He has published 10 research papers in national and international academic journals and his research interest include renal pathology.



Devasenathipathy Kandasamy is Assistant Professor at Department of Radiodiagnosis (IRCH), All India Institute of Medical Sciences, New Delhi, India. He earned the undergraduate degree MBBS from Madras Medical College, Chennai and Postgraduate degree MD (Radiodiagnosis) From All India Institute of Medical Sciences, New Delhi, India. He has published 14 research papers in national and international academic journals and authored six books. His research interests include body imaging and interventions and imaging informatics.



Viveka P. Jyotsna is Associate Professor at Department of Endocrinology at All India Institute of Medical Sciences, Delhi, India. She earned the undergraduate MBBS and postgraduate degree MD, DM form Institute of Medical Sciences, BHU, Varanasi. She has published 40 research papers in national and international academic journals. Her research interests include diabetes and neuroendocrinology.