American Association of Endocrine Surgeons- Annual Meeting Abstract Papers

PARATHYROIDECTOMY IMPROVES NEUROCOGNITIVE DEFICITS IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM
Sanziana Roman, MD, Julie Sosa, MD, Linda Mayes, MD, Eric Desmond, JD, Leon Boudourakis, BA, Elizabeth Holt, MD PhD & Robert Udelsman MD
Yale University School of Medicine, New Haven, CT

Background: Clinical guidelines for the treatment of primary hyperparathyroidism (pHPT) often suggest parathyroidectomy, but assessments generally fail to consider neurocognitive and psychiatric symptoms because of the relative paucity of evidence.
Methods: In this multidisciplinary, prospective study, patients with pHPT (cases) and benign euthyroid thyroid disease (controls) referred for surgery over 7 months were evaluated pre- and post-operatively at 2-4 weeks with validated and innovative psychometric and neurocognitive instruments to determine whether learning, memory, or concentration improved with surgery. Statistical comparisons between groups were performed with a univariate and repeated measures ANOVA.
Results: 55 subjects (43 women) with a mean age of 54.3 years were evaluated pre-operatively; 32 returned for their first post-op visit. There were more men among the cases (75 vs 43%, p=.06), but there was no significant difference between groups by age. Pre-op cases showed greater delays in their spatial learning than controls, as evidenced by fewer correct moves per second across five learning trials (.58, s.d. .18 controls; .52, s.d. .17 cases) and in a delayed response trial (.72, s.d. .26 controls; .60, s.d. .21 cases). Controlling for age and gender, all subjects learned across the five trials, but older subjects (p<.001) and women (p=.002) responded more slowly and cases were more delayed. Compared to pre-op, cases improved post-op in their learning performance after surgery and appear to function at a level equivalent to the control group. There was a trend toward a main effect for gender, in that women showed more recovery to normal neurocognitive function than men (p=.07). Cases also reported more depression symptoms pre-op that were improved post-op. There were no differences between the cases and controls on overall memory function. For cases, average pre-op calcium (11.3 mg/dl ) and PTH (100 pg/ml) normalized post-op.
Conclusions: These Results: suggest that pHPT may be associated with a spatial learning deficit and processing that improves post-surgery. While longer term follow-up is necessary, neurocognitive symptoms should be considered as criteria for parathyroidectomy.