Outcome Study of Psychological Distress and Nonspecific Symptoms in Patients With Mild Primary Hyperparathyroidism—Invited Critique

Abstract

Background: Primary hyperparathyroidism is a common endocrinopathy. The appropriate management of its mild form, however, remains controversial. Hypothesis: Mild primary hyperparathyroidism is associated with psychological distress and other nonspecific symptoms that improve following parathyroidectomy. Design: Two-year prospective before-after study. Setting: University hospital. Patients: Twenty-six consecutive patients with mild hypercalcemia (<12 mg/dL |<3 mmol/L|) due to primary hyperparathyroidism, without osteitis fibrosa cystica or urolithiasis were enrolled from January 11, 1997, through April 21, 1998. Intervention: Parathyroidectomy. Main Outcome Measures: Primary outcome was psychological distress as measured by the 28-item version of the General Health Questionnaire. Secondary outcomes included body weight, joint pain, and occurrences of bowel movements and urination. Results: Before surgery, 15 patients (58%; 95% confidence interval, 37%-77%) showed psychological distress (case group) while 11 patients did not (noncase group). A clinically and statistically significant reduction in the General Health Questionnaire score was de; tected at 3 months in the case group (-6.1; 95% confidence interval, -11.0 to -1.2), but the reduction was smaller (-1.9; 95% confidence interval, -6.9 to 3.0) at 24 months after surgery. No significant change in the General Health Questionnaire score was observed in the noncase group during the follow-up. No significant change was noted in any of the secondary outcomes. Conclusions: Psychological distress was associated with mild primary hyperparathyroidism and was ameliorated after surgery. The improvement, however, was limited in extent and duration.