Abstract
Despite one-quarter of patients with primary hyperparathyroidism (PHPT) experiencing psychiatric symptoms, there remains a dearth of literature regarding the diagnosis and further management of psychiatric sequelae in PHPT. We aim to review the literature pertaining to the epidemiology, disease presentation, pathophysiology, diagnostics, and therapeutics regarding psychiatric sequelae of PHPT with an emphasis on clinical pearls for practicing psychiatrists. A literature search was conducted using the US National Library of Medicine’s PubMed resource using the following keywords in various combinations: primary hyperparathyroidism, neuropsychiatric, calcium, psychosis, mania, depression, catatonia, delirium, parathyroidectomy, and psychotropic medication. We discuss in depth all aspects of the diagnosis and management of psychiatric sequela in PHPT. We have also identified epidemiological trends, discussed the most common clinical presentations, and postulated possible mechanisms for psychiatric symptoms in PHPT. Psychiatrists should maintain diagnostic suspicion for PHPT in older adult female patients presenting with new-onset psychiatric illness. Several mechanisms involving the following may explain the variety of psychiatric symptoms in PHPT: tyrosine hydroxylase, parathyroid hormone, interleukin-6, monoamine oxidase, calcium, and the sodium-potassium adenosine triphosphatase transporter. We recommend psychiatrists take a symptom-oriented approach to management. Treating a patient’s psychosis, mania, depression, catatonia, delirium, or eating disorder pathology via conventional therapeutics seems like a rational approach despite the underlying medical etiology. Only parathyroidectomy has been proven to be definitive in the complete amelioration of psychiatric symptoms.
Highlights
BackgroundPrimary hyperparathyroidism (PHPT) is a disease of autonomous excessive secretion of parathyroid hormone (PTH) from pathologic parathyroid glands
We aim to review the literature pertaining to the epidemiology, disease presentation, pathophysiology, diagnostics, and therapeutics regarding psychiatric sequelae of primary hyperparathyroidism (PHPT) with an emphasis on clinical pearls for practicing psychiatrists
We aim to be the first to comprehensively synthesize and review the collective literature pertaining to the epidemiology, disease presentation, pathophysiology, diagnostics, and therapeutics regarding psychiatric sequelae of PHPT with an emphasis on clinical pearls for practicing psychiatrists
Summary
Primary hyperparathyroidism (PHPT) is a disease of autonomous excessive secretion of parathyroid hormone (PTH) from pathologic parathyroid glands. It is the third most common endocrinological disorder and costs the United States healthcare system hundreds of million dollars annually [1,2]. None of the published review articles comprehensively address the pathophysiology of PHPT-mediated psychiatric disease or evaluate practical concerns in both diagnosis and psychiatric symptom management. This is surprising considering the seemingly ubiquitous education of PHPT-related symptoms in medical schools via the mnemonic “Stones, Bones, Groans, Moans,” with the “moan” component referring to psychiatric manifestations. Our hope is that this review will effectively fill knowledge gaps for curious clinicians as well as provide intellectual scaffolding for future systematic and scientific investigations
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