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Neurocognitive dysfunction: A predictor of parathyroid hyperplasia

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 comple...

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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
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container_issue 6
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container_title Surgery
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creator Repplinger, Daniel, BS
Schaefer, Sarah, NP
Chen, Herbert, MD, FACS
Sippel, Rebecca S., MD
description 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.
doi_str_mv 10.1016/j.surg.2009.09.009
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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 &lt; .001) and 61% of patients reporting 3 or more of these symptoms ( P &lt; .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 &lt; .001). Of patients with 3 or more neurocognitive symptoms and a negative localizing scan, 100% were found to have parathyroid hyperplasia ( P &lt; .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.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2009.09.009</identifier><identifier>PMID: 19958941</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>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</subject><ispartof>Surgery, 2009-12, Vol.146 (6), p.1138-1143</ispartof><rights>Mosby, Inc.</rights><rights>2009 Mosby, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c540t-70c625f822d0ff966ac64f671f254353f0b88dbefd956ceaaf04981461acc80e3</citedby><cites>FETCH-LOGICAL-c540t-70c625f822d0ff966ac64f671f254353f0b88dbefd956ceaaf04981461acc80e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19958941$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Repplinger, Daniel, BS</creatorcontrib><creatorcontrib>Schaefer, Sarah, NP</creatorcontrib><creatorcontrib>Chen, Herbert, MD, FACS</creatorcontrib><creatorcontrib>Sippel, Rebecca S., MD</creatorcontrib><title>Neurocognitive dysfunction: A predictor of parathyroid hyperplasia</title><title>Surgery</title><addtitle>Surgery</addtitle><description>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 &lt; .001) and 61% of patients reporting 3 or more of these symptoms ( P &lt; .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 &lt; .001). Of patients with 3 or more neurocognitive symptoms and a negative localizing scan, 100% were found to have parathyroid hyperplasia ( P &lt; .001). Conclusion The presence of neurocognitive dysfunction in a patient with hyperparathyroidism may be used as a predictor of hyperplastic disease. 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Schaefer, Sarah, NP ; Chen, Herbert, MD, FACS ; Sippel, Rebecca S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c540t-70c625f822d0ff966ac64f671f254353f0b88dbefd956ceaaf04981461acc80e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Cognition Disorders - etiology</topic><topic>Female</topic><topic>Humans</topic><topic>Hyperparathyroidism, Primary - complications</topic><topic>Hyperparathyroidism, Primary - diagnostic imaging</topic><topic>Hyperparathyroidism, Primary - pathology</topic><topic>Hyperparathyroidism, Primary - psychology</topic><topic>Hyperplasia</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgical Procedures</topic><topic>Parathyroid Glands - diagnostic imaging</topic><topic>Parathyroid Glands - pathology</topic><topic>Parathyroid Glands - surgery</topic><topic>Parathyroidectomy</topic><topic>Predictive Value of Tests</topic><topic>Radionuclide Imaging</topic><topic>Radiopharmaceuticals</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery</topic><topic>Technetium Tc 99m Sestamibi</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Repplinger, Daniel, BS</creatorcontrib><creatorcontrib>Schaefer, Sarah, NP</creatorcontrib><creatorcontrib>Chen, Herbert, MD, FACS</creatorcontrib><creatorcontrib>Sippel, Rebecca S., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Repplinger, Daniel, BS</au><au>Schaefer, Sarah, NP</au><au>Chen, Herbert, MD, FACS</au><au>Sippel, Rebecca S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neurocognitive dysfunction: A predictor of parathyroid hyperplasia</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2009-12-01</date><risdate>2009</risdate><volume>146</volume><issue>6</issue><spage>1138</spage><epage>1143</epage><pages>1138-1143</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background To determine whether a symptomatic presentation was associated with parathyroid hyperplasia, we retrospectively examined pre-operative symptom profiles of patients who underwent parathyroidectomy. 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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
title Neurocognitive dysfunction: A predictor of parathyroid hyperplasia
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