Primary hyperparathyroidism in patients with organic brain syndrome

Abstract

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.

Serum ionized calcium and the prevalence of primary hyperparathyroidism in age cohorts of 75, 80 and 85 years

“…The considerable pseudosenile and often curable morbidity associated with HPT [2] warrants biochemical screening and liberal surgery on HPT in the elderly [3]. In geriatric patients, prevalence figures of up to 2.5 % have been reported for hypercalcaemia on the basis of total calcium [4,51 and 5% on the basis of Ca2+ [6], most cases having HPT. However, data for non-selected elderly populations are very scarce.…”

Diagnosis of patients with raised serum calcium level in primary care, Sweden

“…Symptoms of less than two years' duration usually regress after surgery [6] and the risk of higher mortality seems to disappear after 5 Á15 years [7].…”

Dementia Improvement after Primary Hyperparathyroidism Surgery

“…In the present case, the remarkable improvement after parathyroidectomy at all levels may suggest early parathyroidectomy in case of PHPT with significant neurocognitive disturbances even in the absence of other symptoms of PHPT. In addition, this case highlights that, although rare, the underlying undiagnosed asymptomatic PHPT should be considered as a possible cause of dementia, even though asymptomatic PHPT presenting as dementia was reported rarely in the literature [12,13].…”