Two cases of primary hyperparathyroidism with depressive and cognitive symptoms

• Published in: The Journal of nutrition, health & aging health & aging, 2010-11, Vol.14 (9), p.798-799
• Main Authors: Paslakis, G., Gilles, M., Frankhauser, P., Lanczik, O., Deuschle, M., Frölich, L., Müller, F.H.H., Kopf, D.
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Aging; Biological and medical sciences; Cognition Disorders - etiology; Depression; Depressive Disorder - etiology; Diagnostic Errors; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Geriatrics/Gerontology; Humans; Hyperparathyroidism, Primary - complications; Hyperparathyroidism, Primary - diagnosis; Male; Medical sciences; Medicine; Medicine & Public Health; Mood disorders; Neurosciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Nutrition; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Primary Care Medicine; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of Life Research; Short Communication; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-010-0326-0

In this report we present the cases of two patients with depressive symptoms and neurocognitive impairment that had been diagnosed and treated as depression and dementia for years due to missed diagnoses of primary hyperparathyroidism (PHPT) - despite assessed and documented elevated calcium levels. Following parathyroidectomy, a significant improvement in cognition and mood was noticed. Pre- and postoperatively, depression was judged by means of an extensive symptom history interview - including external information from family members - and according to psychopathological findings. An impairment in cognitive measures was assessed using standard neuropsychological tests such as the MMSE and the CERAD battery and with the help of a standard clinical psychiatric interview. An improvement in mood was judged on the basis of patients´ subjective statements, as well as objective clinical observations. The MMSE and the CERAD battery were used in order to evaluate cognitive improvement. This is a first report of CERAD battery findings in two patients before and after parathyroidectomy. In addition, we carried out FDG-PET imaging in these two patients and present the changes in the so-called " metabolic ratio " (MetRat). The metabolic ratio was developed in order to facilitate comparability in quantitative PET analysis between laboratories and describes the ratio of the average metabolic rate of glucose in typically affected regions in Alzheimer ' s disease (temporo-parietal association cortex and frontal association cortex) through that of typically unaffected regions (cerebellum, putamen, primary visual cortex, primary sensorimotor cortex). This ratio was used for the estimation of a post-operative improvement in PET imaging and was interpreted together with clinical findings. To our knowledge, this methodology has not been applied in patients with PHPT so far. Case 1: A 66-year-old female was admitted to the hospital with depressive symptoms and cognitive deficits. The patient had been treated for depression and dementia without sustained response during four hospital stays. Upon admission laboratory values showed a slightly elevated serum calcium (2,92 mmol/l). Elevated calcium levels had been repeatedly assessed and documented for at least 4 years in the past, however, without any further work-up. Further laboratory examinations revealed a considerably elevated intact parathormone (iPTH; 150 ng/l) and a hypercalciuria (11-17 mmol/24h). Thyroid ultrasound reve