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 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).


CONCLUSIONS
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.
Repplinger
Daniel
D
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
Schaefer
Sarah
S
Chen
Herbert
H
Sippel
Rebecca S
RS
D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000523:psychology*; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016105:Parathyroidectomy; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors; D017256:Technetium Tc 99m Sestamibi
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi