Endocrine Abstracts (2011) 26 OC3.3

Evolution of neurobehavioral and cognitive symptoms in patients with primary hyperparathyroidism belonging to the Swiss primary hyperparathyroidism cohort

A Trombetti1, C Meier2, G Gold1, C Torriani1, C Henzen3, F R Herrmann1, E R Christ5, M Braendle4, M E Kraenzlin2 & R Rizzoli1

1University Hospital, Geneva, Switzerland; 2University Hospital, Basel, Switzerland; 3Kantonspital, Luzern, Switzerland; 4Kantonspital, St Gallen, Switzerland; 5University Hospital, Bern, Switzerland.

Objective: To describe the evolution of neurobehavioral and cognitive symptoms in patients with primary hyperparathyroidism as measured by mini-mental state (MMS), Hamilton’s anxiety and depression scale (HADS) and Clock tests. Scores were also compared with biochemical data.

Methods: The Swiss primary hyperparathyroidism (PHPT) Cohort Study is an ongoing, prospective, non-interventional national project collecting clinical, biochemical and outcome data in patients with PHPT. Newly diagnosed patients were enrolled. All three tests applied were interpreted centrally. Thereafter, follow-up data were recorded every 6 months as recommended by the NIH guidelines at the time of study onset. The tests were re-administered on a yearly basis. Patients with parathyroidectomy had one follow-up visit 3 to 6 months after surgery. We applied a multiple regression model comparing test results with serum calcium, serum parathyroid hormone (PTH) and serum 25-hydroxyvitamin D, adjusting for age and gender.

Results: From June 2007 to December 2010, 253 patients (mean age 68.8±14.5 years; 77.5% female) were included. To avoid the effect of age, we limited our analysis to the 100 subjects aged 65 years old and less. Fifty-one had completed at least one of the neuropsychological tests. We found a positive correlation between PTH levels and the HADS anxiety scores (r=0.23, P=0.01) and a negative one with MMS scores (r=−0.13, P=0.03). A Wilcoxon matched-pairs signed-rank test showed an improvement in MMS (P=0.04), anxiety (P=0.01) and depression (P=0.02) scores in the 16 operated patients.

Conclusion: The severity of PHPT as evaluated by serum markers is correlated with impaired cognitive functions, increased anxiety and depression. These alterations may be reversible upon treatment by parathyroidectomy.

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