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Primary hyperparathyroidism (PHT) causes increased bone turnover, leading to reduction in bone mineral density (BMD). Parathyroidectomy is a definitive therapy and improves BMD in adult patients with PHT. However, there are no reports regarding alterations of BMD in pediatric or adolescent patients with PHT. Here, we report a case of a 13-yr-old boy with PHT who was referred to our institution for evaluation of hypercalcemia and hyperparathyroidism. Radiological investigation revealed an ectopic parathyroid adenoma below the right thyroid lobe. A minimally invasive radio-guided parathyroidectomy was successfully performed. We followed up the patient’s BMD for three years both before and after parathyroidectomy. Over the course of three years, his BMD was steadily decreased, with z-scores of +0.506 at 13 yr and 9 mo, +0.162 at 14 yr and 9 mo, and –0.411 at 15 yr and 9 mo. BMD usually increases during peak height velocity in an adolescent and improves after parathyroidectomy in adult patients with PHT. However, our patient showed decreased BMD z-scores following parathyroidectomy. Therefore, the patient had an increased risk of fracture after parathyroidectomy and was followed up closely. Both height and BMD should be carefully evaluated after parathyroidectomy in pediatric and adolescent patients with PHT.

We present the case of a 3-year-old girl with McCune-Albright Syndrome (MAS). She was referred to our clinic for mammary gland enlargement and vaginal bleeding. A right ovarian cyst was detected by abdominal MRI and pelvic ultrasound examination, and it was followed up as a functional cyst. Endocrine studies showed gonadotropin-independent precocious puberty. A bone scintigram, revealed polyostotic fibrous dysplasia. These data confirmed the diagnosis of MAS without skin pigmentation (cafe-au-lait spot). We treated the patient with the aromatase inhibitor, anastrozole (ArimidexR), because of repeated vaginal bleedings. After 6 mo of treatment, the frequency of vaginal bleeding was clearly decreased and the level of estradiol was down to within normal limits. The aromatase inhibitor, anastrozole, appears to be an effective treatment for precocious puberty caused by MAS.