Optimal screening for patients with hyperparathyroidism with use of serum calcium observations. A decision-theoretical analysis

Groth, Torgny; Ljunghall, Sverker; Verdier, C.-H. De

doi:10.1080/00365518309168852

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…The optimal limits of serum calcium in a screening study are often difficult to establish and it seems possible that some undetected cases of HPT may still remain in the screened population with borderline or even normal serum calcium values (13). A normocalcaemic patient with dementia who made remarkable improvement after extirpation of a single parathyroid adenoma has even been reported (14).…”

Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism in patients with organic brain syndrome

Joborn¹,

Hetta²,

Frisk³

et al. 1987

Alzheimer Disease & Associated Disorders

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Joborn C, Hetta J, Frisk P, Palmtr M, Akerstrom G . Ljunghall S. (. Sweden.) Primary hyperparathyroidism in patients with organic brain syndrome. Acta Med Scand 1986; 219: 91-8.In a retrospective study of 552 patients operated on for primary hyperparathyroidism (HIT) the effects of parathyroid surgery were selectively investigated in 13 elderly patients with organic brain syndrome. With a few exceptions, these 13 patients had mild or moderate hypercalcaemia but severe mental impairment. Ten patients had a clinical diagnosis of senile dementia and 12 had been admitted from a mental hospital. Postoperatively, eight patients improved mentally and seven of them were able to return to their homes or could be transferred to somatic units. The eight patients who showed improvement, either temporary or more permanent, had a relatively short duration of mental symptoms preoperatively, all less than 2 years, while those who did not improve mentally after surgery had a longer history of mental illness. Screening for HPT was subsequently performed in a psychogeriatric clinic to investigate the prevalence of HPT in this population. Hypercalcaemia and probable HPT was found in five ( 5 % ) of 101 patients. The results indicate that parathyroidectomy may improve the mental state in patients with HPT and organic brain syndrome. As a substantial number of patients in a psychogeriatric population seem to have HPT. the disease should be searched for in patients with newly diagnosed organic brain syndrome. Key words: calcium, hyperparathyroidism. organic brain syndrome, dementia, surgery.Surgery for primary hyperparathyroidism (HPT) has been carried out in our hospital since 1956. In recent years about 40 patients have been operated on annually. During this time the mode of presentation of HPT has changed from a rather distinct clinical picture with renal stones, predominantly in young and middle-aged persons of both sexes, to a more vague symptomatology . Today the majority of surgically treated cases are elderly females who have uncharacteristic psychiatric or neuromuscular symptoms or appear asymptomatic. At the other end of the spectrum there are some patients who present a clinical picture of disorientation, confusion and lethargy often referred to as (pre)senile dementia, although organic brain syndrome would be a more appropriate denomination. The present investigation was focused on this subgroup of patients. A retrospective study was carried out to determine whether they had benefited from surgery even though they had shown severe mental symptoms preoperatively. Furthermore, in order to assess the magnitude of the problem, screening for HPT was undertaken at a psychogeriatric clinic.Abbreuialions: HPT = hyperparathyroidism, PTH = parathyroid hormone, NOSIE = nurses' observation scale for in-patient evaluation.

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Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism in patients with organic brain syndrome

Joborn¹,

Hetta²,

Frisk³

et al. 1987

Alzheimer Disease & Associated Disorders

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Primary hyperparathyroidism: Epidemiology, diagnosis and clinical picture

et al. 1991

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Primary hyperparathyroidism (HPT) is a common disorder that mainly afflicts elderly women. It can be diagnosed in at least 1% of all postmenopausal females and autopsy studies indicate an even higher frequency. Although the widespread use of automated serum calcium analyses has increased the awareness of HPT, only 10% of all cases seem to be identified. The diagnosis relies on the demonstration of an inappropriately elevated serum concentration of parathyroid hormone (PTH) relative to the serum calcium value, which need not be markedly raised. Measurements of intact PTH with immunometric methods have considerably improved the diagnostic precision but it is still difficult to evaluate patients with only marginal hypercalcemia. Few patients with diagnosed HPT are completely without symptoms. Symptoms commonly encountered are psychiatric and neuromuscular disturbances. Subclinical bone disease might be relevant but there is insufficient information about its importance in otherwise asymptomatic individuals. Various cardiovascular risk factors appear more commonly in patients with HPT and untreated disease is associated with an increased risk of premature death.

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Awareness of hypercalcaemia in a hospital population?

Frølich

McNair

Transbøl

1991

Scandinavian Journal of Clinical and Laboratory Investigation

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In a hospital population all patients with hypercalcaemia were registered consecutively during a 6-month period. Fifty per cent of the patients having hypercalcaemia, which was defined as serum calcium concentrations (albumin corrected) above normal mean + 3 standard deviations, had a serum calcium analysis requested. Of these between 14% and 96%, dependent on the clinical diagnosis and the degree of hypercalcaemia, had the hypercalcaemia identified. Since the prevalence of hypercalcaemia was estimated to be 2.6% and only about 1:4 was identified by the clinicians, correct diagnosis of hypercalcaemia seems to be a problem.

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Optimal screening for patients with hyperparathyroidism with use of serum calcium observations. A decision-theoretical analysis

Cited by 3 publications

References 10 publications

Primary hyperparathyroidism in patients with organic brain syndrome

Primary hyperparathyroidism in patients with organic brain syndrome

Primary hyperparathyroidism: Epidemiology, diagnosis and clinical picture

Awareness of hypercalcaemia in a hospital population?

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