English Polski
Vol 18, No 2 (2021)
Research paper
Published online: 2021-04-01
Page views 515
Article views/downloads 108
Get Citation

Connect on Social Media

Connect on Social Media

Cognitive dysfunctions in patients with primary hyperparathyroidism

Łukasz Kunert1, Jacek Gawrychowski2, Karolina Filipczyk1, Grzegorz Buła2, Robert Pudlo1
Psychiatria 2021;18(2):111-118.


Introduction: Primary hyperparathyroidism (PHPT) is one of the most common endocrine diseases. Somatic problems may be preceded by psychopathological symptoms, especially apathy, fatigue, sleep disorders, affective and anxiety disorders, impairment of cognitive functions, and most significantly — memory deterioration. The aim of the study was to assess the incidence and severity of cognitive impairment in patients with PHPT, as well as a possible relationship between the severity of these disorders and calcium and parathyroid hormone concentrations in serum. Material and methods: The study using the Montreal Cognitive Assessment (MoCA) included 101 patients diagnosed with PHPT. The control group consisted of 50 patients diagnosed with non-toxic thyroid goitre. Results: The analysis of results showed a higher incidence and intensity of cognitive dysfunctions in the group of patients with PHPT, both in the whole population and among women included in the study, and the differences were statistically highly significant. There was no statistically significant difference regarding cognitive dysfunctions incidence between men in the two groups; however, the intensity of these dysfunctions was higher in the group of patients with PHPT. Conclusions: PHPT is associated with a significantly higher incidence of cognitive functions impairment. There was no correlation between the severity of these disorders and calcium or parathyroid hormone levels in serum.

Article available in PDF format

Add to basket: 49.00 PLN

Aready have access?


  1. Saliba W, El-Haddad B. Secondary hyperparathyroidism: pathophysiology and threatment. J Am Board Fam Med. 2009; 22: 574–581.
  2. Pietkiewicz M, Nienartowicz E, Sokołowska-Dąbek D, et al. Hyperparathyroidism: molecular, diagnostic and therapeutic aspects. Postepy Hig Med Dosw. 2010(64): 555–567.
  3. Śliwa K, Marciniak I, Obołończyk Ł, et al. Epidemiology of primary hyperparathyroidism in people aged 55 years and over. Probl Hig Epidemiol. 2010; 91: 248–255.
  4. Krysiak R, Okopień B, Herman ZS. Primary hyperparathyroidism. Pol Arch Med Wewn. 2005; 114: 1016–1024.
  5. Coker LH, Rorie K, Cantley L, et al. Primary hyperparathyroidism, cognition, and health-related quality of life. Ann Surg. 2005; 242(5): 642–650.
  6. Chudziński W, Nawrot I. Clinical picture and diagnosis of hyperparathyroidism. Med Sci Rev Chir Endokrynol. 2006(1): 27–33.
  7. Ljunghall S, Rastad J, Åkerström G. Primary hyperparathyroidism: Epidemiology, diagnosis and clinical picture. World Journal of Surgery. 1991; 15(6): 681–687.
  8. Taniegra E. Hyperparathyroidism. Am Fam Physician. 2004; 69: 333–339.
  9. Conroy S, Moulias S, Wassif W. Primary hyperparathyroidism in the older person. Age and Ageing. 2003; 32(6): 571–578.
  10. Kokot F, Franek E. Parathyroid diseases. In: Szczeklik A. ed. Internal diseases. Medycyna Praktyczna, Kraków 2005: 1088–1090.
  11. Pudlo R, Jarząb M. Mental disorders in parathyroid diseases. In: Gawrychowski J, Jarząb B. ed. Thyroid and parathyroid diseases. Diagnostics and treatment. MediPage, Warszawa 2014: 334–336.
  12. Walker M, Rubin M, Silverberg S. Nontraditional manifestations of primary hyperparathyroidism. J Clin Densitom. 2013; 16: 40–47.
  13. AACE/AAES Task Force on Primary Hyperparathyroidism. The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract. 2005; 11(1): 49–54.
  14. Mihai R, Wass JAH, Sadler GP. Asymptomatic hyperparathyroidism - need for multicentre studies. Clin Endocrinol (Oxf). 2008; 68(2): 155–164.
  15. Pasieka JL, Parsons LL. Prospective surgical outcome study of relief of symptoms following surgery in patients with primary hyperparathyroidism. World J Surg. 1998; 22(6): 513–518.
  16. Alarcón R, Franceschini J. Hyperparathyroidism and Paranoid Psychosis. British Journal of Psychiatry. 2018; 145(5): 477–486.
  17. Watson LC, Marx CE. New onset of neuropsychiatric symptoms in the elderly: possible primary hyperparathyroidism. Psychosomatics. 2002; 43(5): 413–417.
  18. Boonen S, Vanderschueren D, Pelemans W, et al. Primary hyperparathyroidism: diagnosis and management in the older individual. Eur J Endocrinol. 2004; 151(3): 297–304.
  19. Agras S, Oliveau DC. Primary hyperparathyroidism and psychosis. CMAJ. 1964; 91: 1366–1367.
  20. Okamoto T, Kamo T, Obara T. Outcome study of psychological distress and nonspecific symptoms in patients with mild primary hyperparathyroidism. Arch Surg. 2002; 137(7): 779–83; discussion 784.
  21. Wilhelm SM, Lee J, Prinz PR. Major depression due to primary hyperparathyroidism: a frequent and correctable disorder. Am Surg. 2004; 70: 175–179.
  22. Tsukahara K, Sugitani I, Fujimoto Y, et al. Surgery did not improve the subjective neuropsychological symptoms of patients with incidentally detected mild primary hyperparathyroidism. Eur Arch Otorhinolaryngol. 2008; 265(5): 565–569.
  23. Velasco PJ, Manshadi M, Breen K, et al. Psychiatric Aspects of Parathyroid Disease. Psychosomatics. 1999; 40(6): 486–490.
  24. Kunert Ł, Sołtysik M, Buła G, et al. Mental disorders in patients with primary hyperparathyroidism. Psychiatria. 2016; 13(2): 105–115.
  25. Cogan M, Covey C, Arieff A, et al. Central nervous system manifestations of hyperparathyroidism. Am J Med. 1978; 65(6): 963–970.
  26. Numann PJ, Torppa AJ, Blumett i AE. Neuropsychologic deficits associated with primary hyperparathyroidism. Surgery. 1984; 96: 1119–1123.
  27. Brown GG, Preisman RC, Kleerekoper M. Neurobehavioral symptoms in mild primary hyperparathyroidism: related to hypercalcemia but not improved by parathyroidectomy. Henry Ford Hospital Med J. 1987; 35: 211–215.
  28. Goyal A, Chumber S, Tandon N, et al. Neuropsychiatric manifestations in patients of primary hyperthyroidism and outcome following surgery. Indian J Med Sci. 2001; 55: 677–686.
  29. Prager G, Kalaschek A, Kaczirek K, et al. Parathyroidectomy improves concentration and retentiveness in patients with primary hyperparathyroidism. Surgery. 2002; 132(6): 930–936.
  30. Chiang CY, Andrewes DG, Anderson D, et al. A controlled, prospective study of neuropsychological outcomes post parathyroidectomy in primary hyperparathyroid patients. Clin Endocrinol (Oxf). 2005; 62(1): 99–104.
  31. Babińska D, Barczyński M, Stefaniak T, et al. Evaluation of selected cognitive functions before and after surgery for primary hyperparathyroidism. Langenbecks Arch Surg. 2012; 397(5): 825–831.
  32. Trombetti A, Christ ER, Henzen C, et al. Clinical presentation and management of patients with primary hyperparathyroidism of the Swiss Primary Hyperparathyroidism Cohort: a focus on neuro-behavioral and cognitive symptoms. J Endocrinol Invest. 2016; 39(5): 567–576.
  33. Shah-Becker S, Derr J, Oberman BS, et al. Early neurocognitive improvements following parathyroidectomy for primary hyperparathyroidism. Laryngoscope. 2018; 128(3): 775–780.
  34. Storvall S, Ryhänen EM, Heiskanen I, et al. Surgery Significantly Improves Neurocognition, Sleep, and Blood Pressure in Primary Hyperparathyroidism: A 3-Year Prospective Follow-Up Study. Horm Metab Res. 2017; 49(10): 772–777.
  35. Kunert Ł, Gawrychowski J, Sobiś J, et al. Depressive and anxiety disorders in patients with primary hyperparathyroidism. Psychiatria Polska. 2020; 54(6): 1091–1107.
  36. Khan AA, Hanley DA, Rizzoli R, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017; 28(1): 1–19.
  37. Chudek J, Maruniak-Chudek I. Hyperparathyroidism. In: Gawrychowski J, Jarząb B. ed. Thyroid and parathyroid diseases. Diagnostics and treatment. MediPage , Warszawa 2014: 334–336.
  38. Cooper DS, Greenspan FS, Ladenson PW. The thyroid gland. In: Gardner DG, Shoback D. ed. Greenspan's Basic and Clinical Endocrinology. Wydawnictwo Czelej Sp. z o.o., Lublin 2011: 278–281.
  39. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4): 695–699.
  40. Nazem S, Siderowf AD, Duda JE, et al. Montreal cognitive assessment performance in patients with Parkinson's disease with "normal" global cognition according to mini-mental state examination score. J Am Geriatr Soc. 2009; 57(2): 304–308.
  41. Olson RA, Chhanabhai T, McKenzie M. Feasibility study of the Montreal Cognitive Assessment (MoCA) in patients with brain metastases. Support Care Cancer. 2008; 16(11): 1273–1278.
  42. Wong A, Xiong YY, Kwan PWL, et al. The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dement Geriatr Cogn Disord. 2009; 28(1): 81–87.
  43. Talarowska M, Florkowski A, Zboralski K, et al. MoCA and MMSE in the diagnosis of mild cognitive impairment. Psychiatr Psychoterap. 2011; 7(1): 13–20.
  44. Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatry. 2007; 52(5): 329–332.
  45. Alosco ML, Spitznagel MB, van Dulmen M, et al. Cognitive function and treatment adherence in older adults with heart failure. Psychosom Med. 2012; 74(9): 965–973.
  46. Stilley CS, Bender CM, Dunbar-Jacob J, et al. The impact of cognitive function on medication management: three studies. Health Psychol. 2010; 29(1): 50–55.
  47. Insel K, Morrow D, Brewer B, et al. Executive Function, Working Memory, and Medication Adherence Among Older Adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2006; 61(2): P102–P107.
  48. Pasieka JL, Parsons LL, Demeure MJ, et al. Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism. World J Surg. 2002; 26(8): 942–949.
  49. Dotzenrath CME, Kaetsch AK, Pfingsten H, et al. Neuropsychiatric and cognitive changes after surgery for primary hyperparathyroidism. World J Surg. 2006; 30(5): 680–685.
  50. Weber T, Eberle J, Messelhäuser U, et al. Parathyroidectomy, elevated depression scores, and suicidal ideation in patients with primary hyperparathyroidism: results of a prospective multicenter study. JAMA Surg. 2013; 148(2): 109–115.