Improvement of sleep disturbance and neurocognitive function after parathyroidectomy in patients with primary hyperparathyroidism.
OBJECTIVE
To investigate the frequency of the nontraditional symptoms of sleep disturbance and impaired cognitive functioning in patients with primary hyper-parathyroidism (PHPT) and to assess changes in such patients after parathyroidectomy.


METHODS
In this study, we used formal neurocognitive assessment of patients undergoing parathyroidectomy for PHPT. The Brief Sleep Disturbance Inventory assessed sleep disturbance, and Stroop tests evaluated for cognitive impairment. Study patients underwent preoperative and postoperative neurocognitive testing.


RESULTS
Fifty-five patients underwent neurocognitive evaluation; the 43 women and 12 men had a mean age of 63 years. Sleep disturbance was assessed in all 55 patients, whereas evaluation for cognitive impairment was performed in 47. Sleep disturbance was identified preoperatively in 24 (44%) of the 55 patients. This disorder affected 17 (31%) of 55 patients postoperatively (P<0.01). Impaired executive functioning was found at baseline in 6 (13%) of 47 patients and decreased to 1 (2%) of 47 post-operatively (P<0.01), whereas impaired cognitive processing speed was detected in 12 (26%) of 47 patients at baseline and decreased to 3 (6%) of 47 after parathyroidectomy (P<0.01). Eight patients did not meet the National Institutes of Health consensus statement criteria for parathyroidectomy; 4 of these patients had preoperative impairment of sleep or cognitive functioning, 3 of whom showed improvement postoperatively.


CONCLUSIONS
Sleep disturbance and neurocognitive impairment occur in patients with PHPT, and these disorders improve after parathyroidectomy. Further objective evaluation of nontraditional symptoms in patients diagnosed as having PHPT is warranted.
Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Elizabeth A
EA
Mittendorf
Jeffrey S
JS
Wefel
Christina A
CA
Meyers
David
D
Doherty
Suzanne E
SE
Shapiro
Jeffrey E
JE
Lee
Douglas B
DB
Evans
Nancy D
ND
Perrier
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D003072:Cognition Disorders / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010280:Parathyroid Glands / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000601:surgery*
D002118:Calcium