Psychiatric morbidity in primary hyperparathyroidism

Abstract

Summary Psychiatric symptoms are well recognized as a feature of patients with primary hyperparathyroidism. We have applied a standardized psychiatric interview to 15 patients before and after surgery. Thirteen had a lower ‘psychiatric score’ (less psychiatric morbidity) after surgery and improvements were particularly seen in symptoms of fatigue, depression, irritability, sleep disturbance and lack of concentration. The levels of intellectual impairment and of anxiety were unchanged after surgery. The ‘psychiatric scores’ in an additional group of 21 hyperparathyroid patients, in whom a decision to treat conservatively had been made independently, were similar to those in the surgically treated patients after surgery. Among all the untreated patients no relationship was found between overall ‘psychiatric score’ and serum levels of calcium or parathyrin.

Improvement of Sleep Disturbance and Insomnia Following Parathyroidectomy for Primary Hyperparathyroidism

“…The mean age of the cohort was 60.0 ± 1.2 years, and the majority of patients were female (n = 92, 80.0 %). Preoperatively, 72 patients (62.6 %) met the criteria for sleep difficulties based on an ISI score [7, and 29 patients (25.2 %) met the criteria for clinical insomnia (ISI [14). Neither demographic variables, the magnitude of serum calcium and PTH elevations, nor the gland weight were predictive of clinical insomnia (Table 1).…”

“…The majority of previous studies examining sleep disturbance in PHPT have incorporated a single item within a larger subjective questionnaire evaluating numerous non-traditional symptoms, and have conflicting conclusions regarding the effect of parathyroidectomy on sleep disturbance [11,14,15]. Our study is one of the few that focused specifically on sleep disturbance and insomnia in this patient population [25,27,28].…”

“…At present, patients with PHPT typically present with mild hypercalcemia discovered on routine biochemical screening, in association with subtler, nonspecific symptomatology [3]. Nontraditional symptoms associated with PHPT include sleep disturbance, weakness, fatigue, depression, anxiety, irritability, and cognitive dysfunction [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Although these patients are often labeled as ''asymptomatic'' or mildly symptomatic due to the absence of overt symptoms, their disease burden can be quite substantial and have a negative impact on their quality of life [7,9,[19][20][21][22].…”

Screening of an Elderly Population in Primary Care for Primary Hyperparathyroidism

“…Need for pharmacological normalization of serum calcium concentration in the evaluation of moderate hyperparathyroidism in the elderly In the patient with PHPT and neuropsychiatric symptoms, the magnitude of the elevation of serum calcium or parathyroid hormone concentrations is seemingly unrelated to the severity of these symptoms (19,20). To evaluate whether these common and nonspecific symptoms are causally related t o the hypercalcaemia in this group of elderly, where surgical intervention does not appear indicated by conventional criteria, there is a need for a complicationfree and simple medical alternative to the treatment of hypercalcaemia (20), at least during a brief trial period.…”