Neuropsychological Changes and Health-related Quality of Life in Patients with Asymptomatic Primary Hyperparathyroidism

Purpose: Data about neuropsychological impairment and health-related quality of life (HRQOL) in patients with asymptomatic primary hyperparathyroidism (APHPT) is limited. We aimed to investigate the HRQOL, neuropyschological impairment, including depression, anxiety in patients with APHPT who have mildly elevated serum calcium (Ca) levels. Material and Method: Thirty-seven patients with APHPT and 37 controls were included. The Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), and the General Health Questionnaire were administered in all patients, HRQOL was investigated using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Results: Serum levels of Ca and parathyroid hormone (PTH) were significantly higher in patients than in controls [(10.92 +/- 0.66 vs. 9.49 +/- 0.66, p= 0.016, and 133 (34-736) vs. 52.95 (25-75.50), p< 0.001), respectively]. The levels of serum vitamin D were lower in patients than in controls [12.85 (4.0-62.50) vs. 20.30 (5.90-55.00), p= 0.041)]. The patient group had higher BDI scores than controls (12.49 +/- 10.34 vs. 7.46 +/- 5.33, p= 0.011). Patients with APHPT showed lower scores in SF-36 mental health (60.55 +/- 20.75 vs. 69.62 +/- 14.31, p= 0.034), SF-36 physical functioning (55.83 +/- 27.30 vs. 75.67 +/- 24.18, p= 0.002), SF-36 social functioning (66.32 +/- 27.69 vs. 82.08 +/- 14.89, p= 0.003), and SF-36 emotional role functioning (42.55 +/- 37.85 vs. 69.30 +/- 35.43, p= 0.003). The patients showed higher STAI-1 scores (39.95 +/- 11.52 vs. 34.70 +/- 8.01, p= 0.026). We observed that STAI-1 score positively correlated with serum Ca level (r= 0.391; p= 0.018); and PTH (r= 0.341; p= 0.042). Discussion: Our study demonstrated that patients with APHPT have more depressive and anxiety symptoms and lower HRQOL. Our results suggest that HRQOL and neuropsychological changes should also be considered during the clinical follow-up of patients with APHT.