Neurocognitive dysfunction: A predictor of parathyroid hyperplasia

• Published in: Surgery 2009-12, Vol.146 (6), p.1138-1143
• Main Authors: Repplinger, Daniel, BS, Schaefer, Sarah, NP, Chen, Herbert, MD, FACS, Sippel, Rebecca S., MD
• Format: Article
• Language: English
• Subjects: Cognition Disorders - etiology; Female; Humans; Hyperparathyroidism, Primary - complications; Hyperparathyroidism, Primary - diagnostic imaging; Hyperparathyroidism, Primary - pathology; Hyperparathyroidism, Primary - psychology; Hyperplasia; Male; Middle Aged; Minimally Invasive Surgical Procedures; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - pathology; Parathyroid Glands - surgery; Parathyroidectomy; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Risk Factors; Surgery; Technetium Tc 99m Sestamibi
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2009.09.009

Background To determine whether a symptomatic presentation was associated with parathyroid hyperplasia, we retrospectively examined pre-operative symptom profiles of patients who underwent parathyroidectomy. Methods From October 2007 to July 2008, 111 patients with primary hyperparathyroidism completed a preoperative symptom questionnaire prior to parathyroidectomy. The symptom profiles of patients with and without hyperplasia were compared. Results Neurocognitive symptoms occurred in 51.4% of patients. Patients with 1 neurocognitive symptom had a 25% risk of parathyroid hyperplasia. Additional neurocognitive symptoms increased the risk of hyperplasia linearly, with hyperplasia occurring in 38% of patients reporting 2 neurocognitive symptoms ( P < .001) and 61% of patients reporting 3 or more of these symptoms ( P < .001). A negative sestamibi scan was associated with a 33% risk of hyperplasia. Coupled with at least 1 neurocognitive symptom, the risk of hyperplasia was 53.3% ( P < .001). Of patients with 3 or more neurocognitive symptoms and a negative localizing scan, 100% were found to have parathyroid hyperplasia ( P < .001). Conclusion The presence of neurocognitive dysfunction in a patient with hyperparathyroidism may be used as a predictor of hyperplastic disease. Three or more of these symptoms, coupled with a negative sestamibi scan, was 100% predictive of parathyroid hyperplasia in our cohort.