Endocrine Abstracts (2011) 25 P326

The effect of parathyroidectomy on neuropsychological symptoms in patients with asymptomatic primary hyperparathyroidism

Hassan Kahal1, Mo Aye2, Alan Rigby3, Thozhukat Sathyapalan1, James England4 & Stephen Atkin1

1Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Hull, UK; 2Department of Diabetes, Endocrinology, and Metabolism, Hull Royal Infirmary, Hull, UK; 3University of Hull, Hull, UK; 4Department of Otolaryngology Head and Neck Surgery, Hull Royal Infirmary, Hull, UK.

Introduction: With increased biochemical screening primary hyperparathyroidism (pHPT) is discovered incidentally while patients are still asymptomatic.

Objective: To assess the impact of surgery on neuropsychological symptoms in people with apparent asymptomatic pHPT.

Methods: Twenty-four patients with asymptomatic pHPT requiring parathyroidectomy, in accordance with NIH recommendations, were recruited prospectively between May 2005 and August 2007. The control group of 23 subjects was recruited simultaneously from consecutive patients undergoing diagnostic hemithyroidectomy (HT) for cold thyroid nodules. Operations were performed by a single surgeon.

Biochemical investigations and quality of life (QoL), using the hospital anxiety (HAD-A) and depression (HAD-D) scales and the mood rating scale (MRS), were measured preoperatively and 3 months post-operatively. Data are presented as mean and S.D. and analysed using Student’s t-test.

Results: At baseline, patients with pHPT compared to the HT group were older, average age (±S.D.) 60.0 (±13.56) vs 43.0 (±14.56) years, respectively (P<0.001), had more females 93.1% (n=27) vs 70.4% (n=19), and higher scores only on the HAD – D (depression) scale, 14.1 (±4.14) vs 11.0 (±3.49), P=0.0065.

Postoperatively, there was a significant improvement in Qol with a pre and post-op mean change of 2.45 (±2.57), P<0.001 on HAD – A, 2.79 (±3.85), P=0.0017 on HAD – D, and 3.2 (±4.57), P=0.0022 on MRS in patients with pHPT. In the HT group; HAD – A mean change 1.0 (±3.8), P=0.22; HAD – D −0.173 (±3.0), P=0.786; and MRS −0.086 (±4.1), P=0.919.

Postoperatively, calcium and PTH normalised in all patients in the pPTH group; 2.44 (±0.09) mmol/l and 49 (±27.18) ng/l, respectively. Calcium levels remained normal in the HT group. There were no changes in CRP, uric acid, and malondialdehyde levels in either group.

Conclusions: Apparent asymptomatic pHPT is associated with neuropsychological symptoms and a reduced quality of life that improve after parathyroidectomy.

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