Cognition and cerebrovascular function in primary hyperparathyroidism before and after parathyroidectomy.
Autoregulation
Cognition
Primary hyperparathyroidism
Vascular stiffness
Vasomotor reactivity
Journal
Journal of endocrinological investigation
ISSN: 1720-8386
Titre abrégé: J Endocrinol Invest
Pays: Italy
ID NLM: 7806594
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
09
07
2019
accepted:
09
10
2019
pubmed:
18
10
2019
medline:
21
11
2020
entrez:
18
10
2019
Statut:
ppublish
Résumé
There are cognitive changes in primary hyperparathyroidism (PHPT) that improve with parathyroidectomy, but the mechanism of cognitive dysfunction has not been delineated. We assessed if cerebrovascular function is impaired in PHPT, improves post-parathyroidectomy and is associated with PTH level and cognitive dysfunction. This is an observational study of 43 patients with mild hypercalcemic or normocalcemic PHPT or goiter. At baseline, cerebrovascular function (dynamic cerebral autoregulation and vasomotor reactivity) by transcranial Doppler and neuropsychological function were compared between all three groups. A subset underwent parathyroidectomy or thyroidectomy, and was compared 6 months post-operatively. Mean cerebrovascular and neuropsychological function was normal and no worse in PHPT compared to controls preoperatively. Higher PTH was associated with worse intracerebral autoregulation (r = - 0.43, p = 0.02) and worse cognitive performance on some tests. Post-parathyroidectomy, mood improved significantly, but changes did not differ compared to those having thyroidectomy (p = 0.84). There was no consistent improvement in cognition or change in vascular function in either surgical group. Although higher PTH was associated with worse intracerebral autoregulation, cerebrovascular function, cognition and mood were normal in mild PHPT. PTX did not improve vascular or cognitive function. The observed improvement in mood cannot be clearly attributed to PTX. Notwithstanding the small sample size, the results do not support changing current criteria for parathyroidectomy to include cognitive complaints. However, the associations between PTH, cognition and cerebral autoregulation merit future studies in those with more severe hyperparathyroidism.
Identifiants
pubmed: 31621051
doi: 10.1007/s40618-019-01128-0
pii: 10.1007/s40618-019-01128-0
pmc: PMC7275118
mid: NIHMS1541280
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
369-379Subventions
Organisme : NCRR NIH HHS
ID : UL1 RR024156
Pays : United States
Organisme : Endocrine Fellows Foundation
ID : n/a
Organisme : NCRR NIH HHS
ID : UL1RR024156
Pays : United States
Organisme : NIDDK NIH HHS
ID : R21 DK104105
Pays : United States
Organisme : Columbia University Aging Center
ID : n/a
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