Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia

Parks, Kristin A.; Parks, Clayton G.; Onwuameze, Obiora E.; Shrestha, Santosh Man

doi:10.1176/appi.ajp.2017.16111226

Cited by 40 publications

(50 citation statements)

References 18 publications

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“…Erythropoietin was originally thought only to affect RBC production (24), is now known to have effects in the brain as well as other organs (25). PTH has now also joined this list of hormones that affect brain function (7). The concentration of PTH2R in the limbic and neuroendocrine hypothalamus (26,27), afford it an excellent position to affect emotions while its position near the preoptic nucleus enable it to affect somatostatin, cortisol, and ADH that are also known to affect emotion.…”

Section: Discussionmentioning

confidence: 99%

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Mental Effects of Excess Parathyroid Hormone in Hemodialysis Patients: A Possible Role for Parathyroid 2 Hormone Receptor?

Diskin

2019

Ther Apher Dial

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Depression as measured by the kidney disease quality of life (KDQOL) form is known to be an independent risk factor for mortality dialysis patients. Excess parathyroid hormone (PTH) has long been associated with neuropsychiatric disturbances. Those psychiatric complications are currently attributed to hypercalcemia with very little evidence; however, with the discovery of the parathyroid hormone 2 receptor (PTH2R) in the brain which can be activated by PTH, PTH2R might indicate a direct effect of PTH. As secondary and tertiary hyperparathyroidism is common in dialysis patients where the serum calcium is low or normal, we chose to investigate a possible relationship between PTH levels and depression in dialysis patients. This was a matched pair observational study with 10 patients with intact PTH values above 1000 pg/mL who were matched with 10 patients who had PTH values less than 400 pg/mL for the presence of diabetes, years on dialysis, duration of dialysis time, Kt/V, hemoglobin, and 25 OH vitamin D levels, as well as intravenous iron and erythropoietin administration. The Kidney Disease Quality of Life questionnaire (KDQOL-36) scores and patient Health Questionnaire scores were analyzed during that time. All variables underwent tests for normality and matched pair t-test. All subscales of the KDQOL-36 were worse in the high PTH group with the effect on daily life reaching P = 0.01 and the burden of disease and symptoms both reaching P = 0.02. PTH and PTH2R may be appropriate targets for investigations to improve the quality of life in hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

“…• The SF-12 measure of physical (PCS) and mental (MCS) functioning (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12), with items about general health, activity limits, ability to accomplish desired tasks, depression and anxiety, energy level, and social activities. Only intact PTH levels and calcimimetic use were different between the groups.…”

Section: Methodsmentioning

confidence: 99%

Mental Effects of Excess Parathyroid Hormone in Hemodialysis Patients: A Possible Role for Parathyroid 2 Hormone Receptor?

Diskin

2019

Ther Apher Dial

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“…5,6 Neuropsychiatric symptoms in primary hyperparathyroidism are varied and can be easily missed, particularly in the elderly population. 7 It is believed that psychopathology emerges after a prolonged period of subclinical hypercalcaemia with mild-to-moderate hypercalcaemia presenting as depression, apathy, irritability, lack of initiative and severe hypercalcaemia presenting as delirium with psychosis, catatonia or lethargy and possibly coma. [7][8]…”

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confidence: 99%

Psychotic depression due to primary hyperparathyroidism

Waykar¹,

Aziz²,

Eapen³

2019

Prog Neurol Psychiatry

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Neuropsychiatric symptoms in primary hyperparathyroidism are varied and can be easily missed, particularly in elderly population. It is believed that psychopathology emerges after a prolonged period of subclinical hypercalcaemia. This case highlights the importance of baseline tests when assessing patients presenting with mental health symptoms, and the presence of high serum calcium should prompt psychiatrists to consider testing for levels of parathyroid hormone and vitamin D levels.

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“…T he incidence of primary hyperparathyroidism (PHPT) is about 21 cases per 100 000 person-years, and the disorder is usually caused by a solitary parathyroid adenoma. 1,2 There are multiple neuropsychiatric symptoms associated with primary hyperparathyroidism. 2,3 These disturbances can range from anxiety, depression, personality changes to psychotic symptoms and cognitive impairment.…”

mentioning

confidence: 99%

“…1,2 There are multiple neuropsychiatric symptoms associated with primary hyperparathyroidism. 2,3 These disturbances can range from anxiety, depression, personality changes to psychotic symptoms and cognitive impairment. Although a direct mechanism between hypercalcaemia and psychosis has not yet been elucidated, calcium is thought to figure prominently in determining changes in monoamine metabolism in the CNS, thereby modifying neurotransmission and resulting in alterations in mood and cognition.…”

mentioning

confidence: 99%