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Primary Neonatal Severe Hyperparathyroidism

Features

Neonatal severe hyperparathyroidism (NSHPT) is a heritable disorder of mineral homeostasis transmitted as an autosomal recessive trait, caused by loss-of-function mutations in the CASR gene on chromosome 3q13.

Clinical Manifestations

Neonatal severe primary hyperparathyroidism usually manifests in the first 6 months of life with severe hypercalcemia, bone demineralization, and failure to thrive. Early diagnosis is critical because untreated NSHPT can be a devastating neurodevelopmental disorder, which in some cases is lethal without parathyroidectomy. Some infants have milder hyperparathyroidism and a substantially milder clinical presentation and natural history.

Diagnosis

Severe hypercalcemia with low serum phosphate and elevated PTH plasma levels in infants support NSHPT diagnosis.

Genetics

Neonatal severe hyperparathyroidism can be caused by loss-of-function mutations in the CASR gene on chromosome 3q13. The mutations are most often homozygous or compound heterozygous, but de novo heterozygous mutations have been identified. Affected newborns cannot induce a hypercalciuric response to hypercalcemia due to a significant elevated PTH “set-point”, which is much higher than observed in familial hypocalciuric hipercalcemia. Severe neonatal hyperparathyroidism is an autosomal recessive disorder. For the genetic study it will be necessary samples of the index case and the parents.

Treatment

Medical treatment is based on aggressive hydration and if appropriate, bisphosphonates. Parathyroidectomy should be reserved for the most severely affected infants in whom medical therapy has failed.

Prognosis

NSHPT can be a devastating neurodevelopmental disorder, which in some cases is lethal without treatment.

Complications

Severe hyperparathyroidism lead to bone demineralization, and can affect infant development.

References

  1. Pollak, M. R., Brown, E. M., Chou, Y.H. W., Hebert, S. C., Marx, S. J., Steinmann, B., Levi, T., Seidman, C. E., Seidman, J. G. Mutations in the human Ca(2+)-sensing receptor gene cause familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism. Cell 75: 1297-1303, 1993.