Parkinsonism as presenting symptom of primary hyperparathyroidism: Improvement after surgery

Luján-Martínez, Delia; Sánchez-Cifuentes, Ángela; Peña-Ros, Emilio; Albarracín-Marín-Blázquez, Antonio; Candel-Arenas, Mari Fe

doi:10.24875/cirue.m18000015

Cited by 4 publications

(5 citation statements)

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“…Interestingly, short-term normalization of hypercalcemia via calcimimetic treatment and subsequent improvement in depression and anxiety symptoms (according to the Hospital Anxiety and Depression Scale) are good predictors of long-term outcomes after 6 months of parathyroidectomy, especially at the level of the cognitive response (according to the Montreal Cognitive Assessment) and therefore aid in an appropriate patient selection for surgery [46]. It is worth noting that improvement in neurological and psychiatric symptoms following parathyroidectomy was also supported by some case reports [28,[30][31][32]. Despite the evidence-based positive outcomes, parathyroidectomy is still underused for symptomatic PHPT in older adults [47].…”

Section: Surgical Managementmentioning

confidence: 79%

“…A total of 29 articles met the inclusion criteria (Table 1). The studies break down as follows: 5 studies emphasized the epidemiology [7,[23][24][25][26], 8 studies were available with regard to the clinical manifestations [25,[27][28][29][30][31][32][33], 25 studies addressed the treatments [7,15,[23][24][25][27][28][29][30][31][32][34][35][36][37][38][39][40][41][42][43][44][45][46][47], and 7 considered the post-operative complications [7,25,26,37,44,48,49]. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the methodological quality of the included studies and the data are presented in Appendix A (Tables A1-A4).…”

Section: Methodsmentioning

confidence: 99%

“…Patients can also exhibit cognitive, affective, and behavioral manifestations as well as movement disorders [25,[28][29][30][31][32] with even mild hypercalcemia [33]. Neuropsychiatric symptoms include memory loss, disorders of consciousness, sleep disturbance, fatigue, anxiety, and depression, as well as manic, psychotic, and obsessive-compulsive symptoms, among others.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

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Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management

Rizk,

Saad,

Arnaout

et al. 2023

JCM

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Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder among older adults. The aim of this review is to shed light on PHPT, particularly in this age group, in terms of prevalence, clinical manifestations, medical and surgical management, and post-operative complications. Methods: Eligible studies were those considering PHPT exclusively in the older population (main databases: PubMed, Medline, Google Scholar and the University Online database). Articles published in the last 10 years (2013–2023) were considered. Eligibility criteria followed the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. The methodological quality of the studies was assessed using the Joanna Briggs Institute critical appraisal tool. A total of 29 studies (mainly observational) matched the inclusion criteria. Results: The prevalence of PHPT is approximately 1 per 100 in the elderly, and it is more common in females. The clinical presentation varies by age and can include osteoporosis, fractures, and neuropsychiatric symptoms. Conservative management can be an option whenever surgery is not indicated or feasible. However, parathyroidectomy (PTX) remains a safe and effective modality in aging populations with improvement to symptoms, bone mineral density, fracture risk, frailty, quality of life, and metabolic derangements. Complication rates are similar in elderly people compared to younger ones, except for mildly longer length of hospital stay and reoperation for those with higher frailty. Conclusion: PHPT is a common yet overlooked and underdiagnosed condition among the older population. The safety and efficacy of PTX in the older population on different levels is now well demonstrated in the literature.

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Section: Surgical Managementmentioning

confidence: 79%

Section: Methodsmentioning

confidence: 99%

Section: Clinical Manifestationsmentioning

confidence: 99%

See 1 more Smart Citation

Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management

Rizk,

Saad,

Arnaout

et al. 2023

JCM

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“…Parkinson disease is characterized by a decrease in dopaminergic levels in the nigrostriatal pathways of the brain. It is known that calcium is necessary for neuromuscular stimulation and also in neurotransmission (18). Therefore, altered calcium levels affect the transmission of nerve impulses, which could lead to partial or total damage of dopaminergic receptors (2).…”

Section: Discussionmentioning

confidence: 99%

Parkinsonism as an Atypical Manifestation of Primary Hyperparathyroidism

Augusto

Morais

Santana

et al. 2019

AACE Clinical Case Reports

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Objective: Primary hyperparathyroidism (PHPT) occurs as a result of hyperfunctional parathyroid glands resulting in an elevation of serum calcium levels. The association between hypoparathyroidism and parkinsonism have been frequently reported in the literature, while evidence of hyperparathyroidism associated with parkinsonism is rare. Methods: The present study reports a case of a patient that had PHPT and developed symptoms of parkinsonism. Results: A 75-year-old female patient with a history of diabetes mellitus, dyslipidemia, and systemic arterial hypertension presented to the emergency room due to unexplained drowsiness. Her serum calcium at the time was 14.2 mg/dL. A cervical ultrasound was performed, and the presence of a 2.5 × 1.9-cm nodule in the left lower parathyroid region was identified. Three days later, scintigraphy with the use of sestamibi showed an increased capture of the marker in the same region, suggesting parathyroid hyperfunction. During hospitalization, the patient developed symptoms of parkinsonism. A left inferior parathyroidectomy was performed, with normalization of serum calcium levels and a remission of drowsiness, in addition to a significant improvement in parkinsonian symptoms. The patient remained free of parkinsonism over 3 years of follow up. Conclusion: Parathyroidectomy can provide a significant remission of parkinsonism in a patient with PHPT. Even though it is rare, the relation between parkinsonism and PHPT exists. (AACE Clinical Case Rep.

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“…Calcium is vital to normal cell physiology and the function of excitable cells [10,13]. It is known that calcium is necessary for neuromuscular stimulation and also in neurotransmitters [14]. Therefore, altered calcium levels affect the transmission of nerve impulse, which could lead to partial or total damage of dopaminergic receptors [11].Moreover, the Calcium (Ca) concentration in blood serum decreases in PD patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluate the correlation of electrolytes with biochemical parameters in biological samples of Parkinson’s disease patients at different stages

Afridi

Rajput

Kazi

et al. 2020

Preprint

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Background: Neurodegeneration is complex and multifaceted leading to many chronic diseases like Parkinson’s disorder. Electrolytes imbalance have significant role in the pathophysiology of neurological disorders, which might be serve as a bio-indicator of the neurological problems. In present study, the disturbances of electrolytes (calcium, magnesium, sodium and potassium) and its correlation with biochemical parameters in patients with Parkinson’s at different stages with related to referent were studied. Methods: The biological samples were collected from patients recently diagnosed for mild Parkinson disease (MPD) (n=95) as well as chronic PD (CPD) patients, diagnosed for last 5 to 10 years (n=125).The Precision of digestion method was verified by applying matrixes matched certified reference materials of biological samples. The recovery of electrolytes was obtained in the range of 98.4–99.1 % of certified reference materials. The electrolytes concentrations were measured by acid digested biological samples preliminary analysis through flame atomic absorption spectrometry. Results: The experimental data indicated the content of Calcium and Magnesium were found to be higher in scalp hair samples of both patients while Sodium and Potassium showed inverse relation (p<0.05 for both groups). Electrolytes levels in blood serum and plasma was found to be lower in both types of patient groups than healthy groups (p<0.01). Conclusions: These results suggest a disturbance in the elemental homeostasis during the diseases of PD at different stages. In spite of, additional work is proposed to study the actual correlation among micro elemental level and the grade of diseases in neurological sick person.

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Parkinsonism as presenting symptom of primary hyperparathyroidism: Improvement after surgery

Cited by 4 publications

References 5 publications

Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management

Primary Hyperparathyroidism in Older Adults: A Narrative Review of the Most Recent Literature on Epidemiology, Diagnosis and Management

Parkinsonism as an Atypical Manifestation of Primary Hyperparathyroidism

Evaluate the correlation of electrolytes with biochemical parameters in biological samples of Parkinson’s disease patients at different stages

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