Parathyroid Adenoma Causing Hypercalcemic Crisis Masquerading as Acute Abdomen in a 7-Year-Old: Case Report and Systematic Literature Review

Background: Hypercalcemic crisis from a functioning parathyroid adenoma (PA) is exceptionally rare in prepubertal children and typically presents with a non-specific complaint such as polyuria or lethargy. We report a 7-year-old girl who was urgently referred for acute, colicky abdominal pain and repeated vomiting, which clinically mimicked acute appendicitis. During the work-up, extensive metabolic tests incidentally revealed severe hypercalcemia and elevated intact parathyroid hormone (PTH), which led to the diagnosis of PA-induced hypercalcemic crisis.This is the youngest girl reported in Asia whose initial manifestation was an acute abdomen rather than renal or neuropsychiatric symptoms. The case underscores that functioning PA should be included in the differential diagnosis of children presenting with unexplained gastrointestinal distress, and illustrates that prompt recognition and focused parathyroidectomy can achieve rapid normalization of calcium levels without complications. Case Presentation: We report the case of a seven-year-old female patient who was hospitalized due to complaints of abdominal discomfort accompanied by episodes of recurrent vomiting.These symptoms were later found to be related to an underlying fracture. We describe her clinical course, diagnostic workup, and treatment. Laboratory tests revealed severe hypercalcemia (4.67 mmol/L; reference range: 2.1–2.7), along with hypophosphatemia, hypomagnesemia, and markedly elevated parathyroid hormone (268 pg/mL).Contrast-enhanced CT imaging identified a 2.1 cm nodule located posterior to the right thyroid lobe. After urgent management of hypercalcemia—including intravenous fluids, furosemide, salmon calcitonin, and pamidronate—the patient underwent surgical excision of the right inferior parathyroid gland.Histopathological examination confirmed the diagnosis of a benign parathyroid adenoma. Serum calcium and PTH levels normalized within 24 hours postoperatively, with complete resolution of clinical symptoms.During follow-up to date, serum calcium, parathyroid hormone levels, and color Doppler ultrasound examination of the parathyroid have been normal. Conclusions: Parathyroid adenoma represents an uncommon yet manageable cause of hypercalcemic crisis in pediatric patients. Timely assessment of serum calcium and parathyroid hormone levels in individuals presenting with unexplained gastrointestinal symptoms—such as nausea, vomiting, or abdominal pain—facilitates swift diagnosis, thereby reducing the need for unnecessary diagnostic procedures like extensive imaging or invasive tests..