Psychiatric morbidity in primary hyperparathyroidism

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Abstract
This report deals with the psychiatric symptomatology in patients with primary hyperparathyroidism (HPT). In a retrospective search of hospital records, psychiatric symptoms were found in 102 (23%) of 441 patients, 78 of whom had depressive and anxiety states. The presence of psychiatric symptoms was not related to the degree of hypercalcemia. Screening for HPT in 101 old patients hospitalized at a psychogeriatric clinic revealed HPT in 5 (5%) patients. Among 13 patients with organic brain syndrome (e.g., senile dementia) and HPT, 8 patients (with a duration of psychiatric illness of less than 2 years) improved mentally after parathyroid surgery, and could return home or to somatic units. The psychiatric symptomatology was prospectively investigated in 59 consecutive patients with primary HPT (mean serum calcium, 2.89±0.30 mmol/l), using the Comprehensive Psychopathological Rating Scale (CPRS). A majority of the patients had considerable psychiatric symptoms (mean CPRS total score, 13.7±9.1) compared with a healthy control group (mean CPRS total score, 4.4±2.0;p <0.001). The most pronounced psychiatric symptoms among the patients were fatiguability, lassitude, failing memory, concentration difficulties, sadness, and inner tension. Analysis of monoamine metabolites in the cerebrospinal fluid in 48 of the patients revealed subnormal values of 5‐hydroxyindoleaceticacid (5‐HIAA) and homovanillic acid (HVA). At follow‐up, 1–1 1/2 years after parathyroid surgery, there was a marked improvement in mental health in the patients (p <0.001), together with a significant rise in the levels of 5‐HIAA and HVA (p <0.05).Our findings demonstrate that psychiatric symptoms are present in a majority of patients with primary HPT, that the symptoms are reversed by parathyroid surgery, and that their severity seems not to be related to the degree of hypercalcemia. The results also indicate that HPT is associated with changes in the central nervous system turnover of monoamines, of possible importance for the symptomatology.
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  • Medicinska Forskningsrådet

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