PRIMARY HYPERPARATHYROIDISM IN A 14-YEAR-OLD GIRL PRESENTING WITH BONE DEFORMITIES

A 14 year old girl with bilateral genu valgum of 6 years duration was brought for evaluation of primary hyperparathyroidism. She had clinica l features of rickets such as frontal bossing, rachitic rosary, lumbar lordosis and fixed adduction deformity of the left leg. She had under gone osteotomy earlier for correction of these deformities without ben efit. Laboratory investigations showed hypercalcaemia and hypophosphat aemia, with elevated alkaline phosphatase and parathyroid hormone leve ls. A skeletal survey showed generalized decreased density of bone and brown tumours and, coincidentally, a right renal calculus. A computer ized tomography scan of the neck and thallium-technetium subtraction s can delineated an adenoma of the left superior parathyroid gland, whic h was surgically removed. Parathyroid adenoma manifesting with bone de formities, especially genu valgum, is very rare in children. Early dia gnosis and prompt treatment is essential to prevent such deformities.