Neuropsychologic changes in primary hyperparathyroidism after parathyroidectomy from a dual-institution prospective study

Liu, Jessica Y.; Peine, Brandon S.; Mlaver, Eli; Patel, Snehal G.; Weber, Collin J.; Saunders, Neil; Pofahl, Walter E.; Sharma, Jyotirmay

doi:10.1016/j.surg.2020.06.006

Cited by 24 publications

(47 citation statements)

References 23 publications

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“…Since then, several studies have recognized the efficacy of parathyroidectomy in ameliorating PHPT-induced psychiatric symptoms [26,41]. In a large prospective study, Liu et al demonstrated a significant reduction in depressive and anxious symptoms post-parathyroidectomy and recommended considering neuropsychiatric symptoms as a relative indication for surgical intervention [43]. Some publications estimate that psychiatric symptoms resolve over the course of weeks to months after parathyroidectomy [26].…”

Section: Managementmentioning

confidence: 99%

A Clinical Review of the Psychiatric Sequelae of Primary Hyperparathyroidism

Serdenes¹,

Lewis²,

Chandrasekhara³

2021

Cureus

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Despite one-quarter of patients with primary hyperparathyroidism (PHPT) experiencing psychiatric symptoms, there remains a dearth of literature regarding the diagnosis and further management of psychiatric sequelae in PHPT. We aim to review the literature pertaining to the epidemiology, disease presentation, pathophysiology, diagnostics, and therapeutics regarding psychiatric sequelae of PHPT with an emphasis on clinical pearls for practicing psychiatrists. A literature search was conducted using the US National Library of Medicine's PubMed resource using the following keywords in various combinations: primary hyperparathyroidism, neuropsychiatric, calcium, psychosis, mania, depression, catatonia, delirium, parathyroidectomy, and psychotropic medication. We discuss in depth all aspects of the diagnosis and management of psychiatric sequela in PHPT. We have also identified epidemiological trends, discussed the most common clinical presentations, and postulated possible mechanisms for psychiatric symptoms in PHPT. Psychiatrists should maintain diagnostic suspicion for PHPT in older adult female patients presenting with new-onset psychiatric illness. Several mechanisms involving the following may explain the variety of psychiatric symptoms in PHPT: tyrosine hydroxylase, parathyroid hormone, interleukin-6, monoamine oxidase, calcium, and the sodium-potassium adenosine triphosphatase transporter. We recommend psychiatrists take a symptom-oriented approach to management. Treating a patient's psychosis, mania, depression, catatonia, delirium, or eating disorder pathology via conventional therapeutics seems like a rational approach despite the underlying medical etiology. Only parathyroidectomy has been proven to be definitive in the complete amelioration of psychiatric symptoms.

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Section: Managementmentioning

confidence: 99%

A Clinical Review of the Psychiatric Sequelae of Primary Hyperparathyroidism

Serdenes¹,

Lewis²,

Chandrasekhara³

2021

Cureus

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“…Nei paesi sviluppati, in cui la diagnosi di IPP viene fatta per lo più in pazienti asintomatici o con sintomi lievi, manca una valutazione psichiatrica specialistica di routine, nonostante sia dimostrato come il 27,5% dei pazienti con IPP avesse depressione da moderata a grave e il 18% dei pazienti avesse un'ansia generale da moderata a grave, ridotte rispettivamente all'8,2 e al 5,3% dopo PTx. Inoltre, è noto come disturbi neuropsicologici, primi fra tutti ansia e depressione, influenzino le funzioni cognitive [28]. Molti lavori dimostrano che nei pazienti trattati con PTx si ha un netto miglioramento della sintomatologia psichiatrica; tuttavia, la qualità delle prove a sostegno di questa raccomandazione rimane non soddisfacente.…”

Section: Manifestazioni Neuropsichiatriche E Funzione Cognitivaunclassified

“…Molti lavori dimostrano che nei pazienti trattati con PTx si ha un netto miglioramento della sintomatologia psichiatrica; tuttavia, la qualità delle prove a sostegno di questa raccomandazione rimane non soddisfacente. A questo proposito, un recente studio condotto da Liu e colleghi [28] ha dimostrato come ci sia un netto miglioramento dei sintomi neuropsichiatrici dopo PTx rispetto a un gruppo di controllo sottoposto a tiroidectomia per patologia tiroidea. Un punto di forza dello studio risiede nel fatto che la maggior parte degli studi condotti fino ad ora era di tipo osservazionale, mentre gli autori in questo caso hanno somministrato specifici test validati, in particolare la Patient Health Questionnaire-9 (PHQ9) e il disturbo d'ansia generalizzato-7 (GAD7), che sono scale abitualmente utilizzate e validate nella popolazione generale per lo screening rispettivamente di depressione e ansia generalizzata.…”

Section: Manifestazioni Neuropsichiatriche E Funzione Cognitivaunclassified

Manifestazioni non classiche dell’iperparatiroidismo primario: nuove evidenze?

et al. 2021

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SommarioLe manifestazioni cliniche non classiche dell’iperparatiroidismo primario, quali quelle cardiovascolari, gastrointestinali, neuromuscolari e articolari, disturbi neuropsicologici e decadimento cognitivo, alterazione dell’ematopoiesi e un aumentato rischio oncologico, a differenza di quelle a carico dello scheletro e del rene, non vengono ad oggi indagate in maniera sistematica nello studio del paziente con tale patologia; mancano inoltre dati univoci sulla loro epidemiologia, sulle caratteristiche cliniche, sulle conseguenze sulla qualità di vita e sulle possibili modificazioni dopo intervento di paratiroidectomia. In questa rassegna verranno trattate le recenti evidenze presenti in letteratura riguardo la presenza di complicanze definite non classiche.

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“…The SF-36 questionnaire has previously been used to evaluate a wide array of different populations, including older urban adults, surgical nurses, or middle-aged Swedish general population, or to evaluate the status during certain diseases or following treatment (i.e. after burn injuries or hip arthroplasty) ( 8 , 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…Symptoms and QoL remained better after 10 years follow-up ( 12 ). Several publications have described a higher proportion of patients with neuropsychological symptoms before PTx as compared to control groups without PHPT as well as significant decrease in the proportion of patients with depression or anxiety after PTx ( 9 , 13 , 14 ). Follow-up periods range from 19 days to 12 months after PTx.…”

Section: Introductionmentioning

confidence: 99%

Changes in quality of life 6 months after parathyroidectomy for primary hyperparathyroidism

Christensen

Thøgersen

Jensen

et al. 2022

Endocrine Connections

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Objective: The extent of symptoms due to primary hyperparathyroidism depends on the population being studied. Primary hyperparathyroidism is mainly discovered incidentally through routine laboratory findings. Less is known about patient-experienced improvement following successful parathyroidectomy. The aim of our study was to assess changes in Quality of Life after successful surgery using an SF-36 questionnaire. Design: This is a prospective cohort study based on questionnaires. Methods: Forty consecutive patients diagnosed with primary hyperparathyroidism were prospectively administered an SF-36 questionnaire before and 6 months after successful parathyroidectomy. A subgroup of 18 patients answered the questionnaire at 1 and 3 months after surgery. Successful surgery was based on biochemistry and pathology reports as confirmed by an endocrinologist. Results of each SF-36 subcategory were compared to results at baseline in order to detect changes in patient-reported quality of life after successful surgery. Results: There were significant improvements in six of eight SF-36 subcategories: Vitality (P = 0.0001), Physical functioning (P = 0.04), General health perception (P = 0.004), Physical role functioning (P = 0.04), Social role functioning (P = 0.004) and Mental health perception (P = 0.0001). Changes appeared within a month after surgery with no further significant changes at later time points. Conclusions: Parathyroidectomy significantly improves QoL as measured by a decrease in SF-36 scores as early as 1 month after successful parathyroidectomy. The SF-36 QoL questionnaire is suitable for monitoring changes in patient wellbeing after successful parathyroidectomy.

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Neuropsychologic changes in primary hyperparathyroidism after parathyroidectomy from a dual-institution prospective study

Cited by 24 publications

References 23 publications

A Clinical Review of the Psychiatric Sequelae of Primary Hyperparathyroidism

A Clinical Review of the Psychiatric Sequelae of Primary Hyperparathyroidism

Manifestazioni non classiche dell’iperparatiroidismo primario: nuove evidenze?

Changes in quality of life 6 months after parathyroidectomy for primary hyperparathyroidism

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