Casella Claudio, Pata Giacomo, Di Betta Ernesto, Nascimbeni Riccardo
Università degli Studi di Brescia, Cattedra di Chirurgia Generale, I Divisione di Chirurgia Generale, Spedali Civili di Brescia.
Ann Ital Chir. 2008 May-Jun;79(3):157-61; discussion 161-3.
The clinical presentation of primary hyperparathyroidism (pHPT), previously constantly characterized by bone and renal diseases, has been changing during last years. Several Studies report psychic and behavioural symptoms mostly vague and aspecific, particular in elderly patients, such as asthenia, anxiety, depression, irritability, mood swings, amnestic and cognitive disturbances, severe psychosis. In case history hereby reported 11.8% of the patients affected by pHPT (16 out of 136 cases operated from 1983 to October 2006) who underwent to parathyroidectomy, presented only neuro-cognitive and/or psychiatric symptoms. A relevant association has been found between clinical presentation and age: patients showing neuro-cognitive and psychiatric disturbances were older compared to those suffering from the classical bone and kidney disease. No significant correlation neither with serum calcemia nor with PTH serum levels and severity of the symptomatology was demonstrated A statistically significant reduction of the anxious-depressive disturbances one month post surgery has been found (p < 0.05), and an improvement, though not significant, of the neuro-cognitive and psychiatric alterations was registered (p > 0.1). The Authors believe neuro-cognitive or psychic manifestations is not to be neglected, mainly in geriatric patients: frequently the aspecific symptomatology is not referred as hypercalcemia due to pHPT Neuro-psychic symptomatology should be considered an indication for surgical treatment.
原发性甲状旁腺功能亢进症（pHPT）的临床表现以往一直以骨骼和肾脏疾病为特征，但在过去几年中发生了变化。多项研究报告称，精神和行为症状大多模糊且不具特异性，在老年患者中尤为明显，如乏力、焦虑、抑郁、易怒、情绪波动、记忆和认知障碍、严重精神病等。在此报告的病例中，接受甲状旁腺切除术的pHPT患者（1983年至2006年10月手术的136例病例中的16例）中，有11.8%仅表现出神经认知和/或精神症状。研究发现临床表现与年龄之间存在显著关联：出现神经认知和精神障碍的患者比患有经典骨骼和肾脏疾病的患者年龄更大。未发现与血清钙血症、PTH血清水平及症状严重程度有显著相关性。术后1个月焦虑抑郁障碍有统计学显著降低（p<0.05），神经认知和精神改变虽无显著改善，但有好转（p>0.1）。作者认为神经认知或精神表现不容忽视，主要是在老年患者中：由于pHPT导致的非特异性症状往往未被归因于高钙血症。神经精神症状应被视为手术治疗的指征。
