title: Primary hyperparathyroidism, cognition, and health-related quality of life.
abstract: OBJECTIVE
  To provide a rigorous and critical review of studies in which formal neuropsychological (NP) testing and measurement of health-related quality of life (HRQL) were conducted pre- and post-parathyroidectomy for primary hyperparathyroidism (PHPT). These data contribute to the discussion on the utility of surgical intervention for nonclassic PHPT.
  
  
  BACKGROUND
  PHPT is a complex endocrinopathy involving calcium metabolism and a potent hormone made by the parathyroid glands. Approximately 1.5% of Americans age 65 years and older, representing more than 3.9 million people, have PHPT, and the prevalence in postmenopausal women is estimated at 3.4%. Current National Institutes of Health guidelines for curative, surgical intervention of PHPT exclude 80% of patients with hyperparathyroid disease who have subjective neurobehavioral and physical symptoms that affect the quality of their lives.
  
  
  METHODS
  An electronic search was conducted of prospective studies in which cognitive functioning was measured with formal NP tests and HRQL was measured with valid and reliable instruments before and following parathyroidectomy for PHPT.
  
  
  RESULTS
  : In studies conducted pre- and post-parathyroidectomy for PHPT, 6 small studies of cognitive functioning report inconsistent findings; however, 7 well-designed studies of HRQL report improvement across multiple domains following surgery.
  
  
  CONCLUSIONS
  Surgical treatment of PHPT is a viable option for patients with laboratory diagnosed, "nonclassic" PHPT. Formal NP testing and evaluation of HRQL are useful tools that may assist physicians in choosing whom to refer for parathyroidectomy. Further longitudinal study of NP functioning and HRQL in patients with laboratory diagnosed PHPT is warranted.
authors.affiliation: Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. lcoker@wfubmc.edu
authors.forename: Laura H
authors.initials: LH
authors.lastname: Coker
authors.forename: Kashemi
authors.initials: K
authors.lastname: Rorie
authors.forename: Larry
authors.initials: L
authors.lastname: Cantley
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kirkland
authors.forename: David
authors.initials: D
authors.lastname: Stump
authors.forename: Nicole
authors.initials: N
authors.lastname: Burbank
authors.forename: Terry
authors.initials: T
authors.lastname: Tembreull
authors.forename: Jeff
authors.initials: J
authors.lastname: Williamson
authors.forename: Nancy
authors.initials: N
authors.lastname: Perrier
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods; D011184:Postoperative Period; D011300:Preoperative Care; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors