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Introduction. Primary hyperparathyroidism is rare pathology in children (2?5:100,000). In more than 85% of patients, a single adenoma is present, and its extirpation is usually the only treatment a patient requires. In approximately 15?80% of cases, ectopic mediastinal parathyroid tissue can be found inside the thymus. Case outline. Our patient was a 13-year-old boy, who presented with multiple bone fractures in the previous period of time, and fatigue. Parathyroid hormone levels preoperatively were extremely high (1320 pg/ml ? more than 19 times higher than normal). Serum calcium was also elevated (total 3.55 mmol/l; ionized 1.41 mmol/l). He was examined and diagnosed as primary hyperparathyroidism by a pediatric endocrinologist. Imaging procedures for the preoperative localization of parathyroid adenomas were done (99mTc sestamibi scintigraphy and magnetic resonance imaging suggested ectopic mediastinal parathyroid adenoma). The patient underwent video-assisted thoracoscopic surgery procedure. After exploration of the mediastinum and chest, no ectopic parathyroid tissue was found, so total thoracoscopic thymectomy was performed. Final pathological section confirmed parathyroid adenoma inside the thymus. Conclusion. We believe that if no parathyroid tissue is found during surgical exploration of mediastinum, in a child with preoperatively detected parathyroid adenoma in anterior mediastinum, recommendation is to think about possible intrathymic localization and consider removing the thymus. Greater sample size is necessary for higher reliability of this statement.

Introduction. Sheehan syndrome (ShS) is (pan)hypopituitarism because of postpartum pituitary infarction due to massive obstetrical hemorrhage. Enlargement of the pituitary gland, smaller sellar region, disseminated intravascular coagulation (DIC) or autoimmunity are predisposing factors. The absence of lactation after labor and inability to resume the menstrual cycle later are presenting symptoms. Some of patients with Sheehan's syndrome have a sudden onset of severe hypopituitarism immediately after labor, most often in the form of severe hyponatremia. Central adrenal insufficiency is the most usual cause of hyponatremia, although in some cases the syndrome of inappropriate antidiuretic hormone secretion has been also described. Case outline. The female patient, 39-year-old, was admitted to the Intensive Care Unit due to severe hyponatremia with neurological symptoms (Na 103 mmol/L, Cl 72 mmol/L, K 3.7 mmol/L), and absence of lactation. Previously, on the sixth postpartum day, she was admitted to the Obstetrics and Gynecology Clinic due to severe headache, nausea, vomiting, and blurred vision. The symptoms persist from the labor, which was complicated with severe hemorrhage (1000 ml) due to obstetric complications. Treatment began with the 3% hypertonic saline solution with restriction of fluid intake. In regard to panhypopituitarism, replacement therapy with hydrocortisone and levothyroxine was initiated. Diabetes insipidus was excluded. Growth hormone replacement therapy and combination of progesterone and progestogens was started during follow-up. Conclusion. Early diagnosis of Sheehan's syndrome is essential. Pituitary insufficiency in these patients has a great diversity in presentation, that can sometimes result in coma and death.