Department of Internal Medicine, Horsens Regional Hospital, 8700 Horsens, Denmark.
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8000 Aarhus, Denmark.
J Bone Miner Res. 2024 Aug 5;39(7):855-866. doi: 10.1093/jbmr/zjae063.
Hypoparathyroidism (HypoPT) is a disease with no/or inadequate production/secretion of parathyroid hormone (PTH) from the parathyroid glands. Low levels of PTH result in hypocalcemia, which is often treated with calcium supplementation and active vitamin-D analogs. However, increasing evidence suggests that HypoPT has a profound impact on several organ systems. Quality of life (QOL) is reduced in patients with HypoPT, partly due to symptoms related to the central nervous system-including subjective feelings of confusion, a reduced ability to focus and think clearly (ie, "brain fog"). However, the extent to which these complex symptoms relate to quantifiable changes in patients' cognitive performance as determined by neuropsychological tests remains unclear. The brains of HypoPT patients may reveal tissue calcifications, but the extent to which long-term brain exposure to low PTH levels and/or changing calcium levels affects brain structure is unknown. In a cross-sectional study, we investigated PTH levels, QOL, cognitive impairment, and brain structure in well-treated post-surgical and non-surgical hypoparathyroid patients compared with healthy controls. QOL was quantified by the SF36v2, WHO-5 wellbeing Index, and two disease-specific questionnaires-the HPQ28 and Hypoparathyroidism Symptom Diary. Cognitive functions were tested using comprehensive neuropsychological. Brain structure was quantified by morphological analyses of magnetic resonance imaging images. We found reduced QOL and cognitive functioning in terms of processing speed, executive functions, visual memory, and auditory memory in HypoPT. Furthermore, HypoPT revealed a reduced volume of the hippocampus-and the size of the thalamus in postsurgical patients was associated with the disease duration. Importantly, patients reporting severe brain fog had a smaller hippocampus than those with less brainfog. HypoPT is associated with quantifiable cognitive deficits and changes in brain structure that align with patient symptoms. Our exploratory study warrants further studies of the neurobiological impact of PTH and of the impact of PTH replacements therapy on patients' cognitive functioning.
甲状旁腺功能减退症（HypoPT）是一种由甲状旁腺分泌或产生甲状旁腺激素（PTH）不足的疾病。PTH 水平降低会导致低钙血症，通常通过补钙和活性维生素 D 类似物治疗。然而，越来越多的证据表明 HypoPT 对多个器官系统有深远的影响。HypoPT 患者的生活质量（QOL）下降，部分原因是与中枢神经系统相关的症状，包括主观上感到困惑、注意力和思维清晰度降低（即“脑雾”）。然而，这些复杂的症状在多大程度上与神经心理学测试确定的患者认知表现的量化变化有关尚不清楚。HypoPT 患者的大脑可能会出现组织钙化，但长期暴露于低 PTH 水平和/或钙水平变化对大脑结构的影响程度尚不清楚。在一项横断面研究中，我们调查了经治疗的手术后和非手术性 HypoPT 患者与健康对照组之间的 PTH 水平、QOL、认知障碍和大脑结构。QOL 通过 SF36v2、世界卫生组织-5 幸福感指数和两个疾病特异性问卷——HPQ28 和甲状旁腺功能减退症症状日记来量化。认知功能使用综合神经心理学测试进行测试。大脑结构通过磁共振成像图像的形态学分析进行量化。我们发现 HypoPT 患者的 QOL 和认知功能在处理速度、执行功能、视觉记忆和听觉记忆方面都有所下降。此外，HypoPT 患者的海马体体积减小，且手术后患者的丘脑体积与疾病持续时间相关。重要的是，报告严重脑雾的患者的海马体比脑雾较轻的患者小。HypoPT 与可量化的认知缺陷和与患者症状一致的大脑结构变化有关。我们的探索性研究证明了 PTH 的神经生物学影响以及 PTH 替代治疗对患者认知功能的影响值得进一步研究。
