Neurological and psychiatric disorders in primary hyperparathyroidism: the role of parathyroidectomy.

Abstract

The clinical presentation of primary hyperparathyroidism (pHPT), previously constantly characterized by bone and renal diseases, has been changing during last years.

Several Studies report psychic and behavioural symptoms mostly vague and aspecific, particulary in elderly patients, such as asthenia, anxiety, depression, irritability, mood swings, mnestic and cognitive disturbances, severe psycosis.

In case history hereby reported 11.8% of the patients affected by pHPT (16 out of 136 cases operated from 1983 to october 2006) who underwent to parathyroidectomy, presented only neuro-cognitive and/or psychiatric symptoms.

A relevant association has been found between clinical presentation and age: patients showing neuro-cognitive and psychiatric disturbances were older compared to those suffering from the classical bone and kidney disease.

No significant correlation neither with serum calcemia nor with PTH serum levels and severity of the symptomatology was demonstrated.

A statistically significant reduction of the anxious-depressive disturbances one month post surgery has been found (p<0.05), and an improvement, though not significant, of the neuro-cognitive and psychiatric alterations was registered (p>0.1).

The Authors believe neuro-cognitive or psychic manifestations is not to be neglected, mainly in geriatric patients: frequently the aspecific symtomathology is not referred as hypercalcemia due to pHPT.

Neuro-psychico symtomathology should be considered an indication for surgical treatment.