Linder J, Brimar K, Granberg P O, Wetterberg L, Werner S
Department of Psychiatry, St. Göran's Hospital, Karolinska Institute, Stockholm, Sweden.
Acta Psychiatr Scand. 1988 Jul;78(1):32-40. doi: 10.1111/j.1600-0447.1988.tb06298.x.
Psychiatric symptoms in primary hyperparathyroidism (PHPT) are usually characterized as depressive. In this study 13 patients with PHPT and six control patients with atoxic nodular goiter underwent psychiatric ratings with the comprehensive psychopathological rating scale (CPRS) the day before surgery. The 21 items in this scale were grouped into clusters. The ratings were repeated after successful removal of a parathyroid adenoma. Diurnal serum concentrations of cortisol, melatonin and prolactin were studied pre- and postoperatively in eight of the patients. Patients with PHPT had significantly higher CPRS total scores, 8.5 +/- 1.3, compared with goiter controls, 1.9 +/- 0.8, and showed a significant improvement of psychiatric symptoms after excision of the parathyroid adenoma, to 3.3 +/- 0.9. The preoperative diurnal and peak levels of cortisol and melatonin were higher (P less than 0.05) than after surgery. Serum melatonin fell to levels lower than those in healthy controls. Correlations were found between some clusters or items and cortisol or melatonin. Serum prolactin levels were normal and unaltered by parathyroid surgery. It is concluded that patients with PHPT show well defined psychiatric symptoms many of which are correlated to alterations in serum cortisol and melatonin accompanying PHPT. The improvement of symptoms seen after successful surgery further suggests that PHPT is associated with a specific psychiatric disorder similar to but distinguishable from major depressive disorder.
原发性甲状旁腺功能亢进症（PHPT）的精神症状通常表现为抑郁。在本研究中，13例PHPT患者和6例毒性结节性甲状腺肿对照患者在手术前一天接受了综合精神病理学评定量表（CPRS）的精神评定。该量表中的21个项目被分组归类。在成功切除甲状旁腺腺瘤后重复进行评定。对其中8例患者在术前和术后研究了皮质醇、褪黑素和催乳素的日间血清浓度。PHPT患者的CPRS总分显著高于甲状腺肿对照患者，分别为8.5±1.3和1.9±0.8，并且在切除甲状旁腺腺瘤后精神症状有显著改善，降至3.3±0.9。术前皮质醇和褪黑素的日间及峰值水平高于术后（P<0.05）。血清褪黑素降至低于健康对照者的水平。发现某些组或项目与皮质醇或褪黑素之间存在相关性。血清催乳素水平正常，且不受甲状旁腺手术影响。得出的结论是，PHPT患者表现出明确的精神症状，其中许多与PHPT伴发的血清皮质醇和褪黑素改变相关。手术成功后症状的改善进一步表明，PHPT与一种特定的精神障碍相关，该障碍与重度抑郁症相似但又有区别。
