title: Clinical presentation and management of patients with primary hyperparathyroidism of the Swiss Primary Hyperparathyroidism Cohort: a focus on neuro-behavioral and cognitive symptoms.
abstract: OBJECTIVE
  To describe the clinical and biochemical profile of patients with primary hyperparathyroidism (PHPT) of the Swiss Hyperparathyroidism Cohort, with a focus on neurobehavioral and cognitive symptoms and on their changes in response to parathyroidectomy.
  
  
  METHODS
  From June 2007 to September 2012, 332 patients were enrolled in the Swiss PHPT Cohort Study, a nationwide prospective and non-interventional project collecting clinical, biochemical, and outcome data in newly diagnosed patients. Neuro-behavioral and cognitive status were evaluated annually using the Mini-Mental State Examination, the Hospital Anxiety and Depression Scale, and the Clock Drawing tests. Follow-up data were recorded every 6 months. Patients with parathyroidectomy had one follow-up visit 3-6 months' postoperatively.
  
  
  RESULTS
  Symptomatic PHPT was present in 43 % of patients. Among asymptomatic patients, 69 % (131/189) had at least one of the US National Institutes for Health criteria for surgery, leaving thus a small number of patients with cognitive dysfunction or neuropsychological symptoms, but without any other indication for surgery. At baseline, a large proportion showed elevated depression and anxiety scores and cognitive dysfunction, but with no association between biochemical manifestations of the disease and test scores. In the 153 (46 %) patients who underwent parathyroidectomy, we observed an improvement in the Mini-Mental State Examination (P = 0.01), anxiety (P = 0.05) and depression (P = 0.05) scores.
  
  
  CONCLUSIONS
  PHPT patients often present elevated depression and anxiety scores and cognitive dysfunction, but rarely as isolated manifestations. These alterations may be relieved upon treatment by parathyroidectomy.
authors.affiliation: Bone Diseases Service, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland. Andrea.Trombetti@hcuge.ch.
authors.forename: A
authors.initials: A
authors.lastname: Trombetti
authors.affiliation: Division of Endocrinology, Diabetes, and Clinical Nutrition, Bern University Hospital, Freiburgstrasse 4, 3010, Bern, Switzerland.
authors.forename: E R
authors.initials: ER
authors.lastname: Christ
authors.affiliation: Department of Medicine, Kantonsspital, Spitalstrasse, Lucerne, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Henzen
authors.affiliation: Division of Geriatrics, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Gold
authors.affiliation: Division of Endocrinology and Diabetes, Department of Internal Medicine, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Brändle
authors.affiliation: Bone Diseases Service, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.
authors.forename: F R
authors.initials: FR
authors.lastname: Herrmann
authors.affiliation: Bone Diseases Service, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Torriani
authors.affiliation: Thoracic and Endocrine Surgery, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Triponez
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Universitätsspital Basel, Spitalstrasse 21/Petersgraben, 4031, Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Kraenzlin
authors.affiliation: Bone Diseases Service, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211, Geneva 14, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Rizzoli
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Universitätsspital Basel, Spitalstrasse 21/Petersgraben, 4031, Basel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Meier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology / Q000601:surgery*; D003072:Cognition Disorders / Q000209:etiology / Q000601:surgery*; D003863:Depression / Q000209:etiology / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016105:Parathyroidectomy; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
keywords: Anxiety; Clinical profile; Depression; Parathyroidectomy