Cognition and cerebrovascular function in primary hyperparathyroidism before and after parathyroidectomy

Area of Science:

• Endocrinology
• Neurology
• Neurosurgery

Background:

• Cognitive changes are reported in primary hyperparathyroidism (PHPT), potentially improving after parathyroidectomy.
• The underlying mechanisms, particularly cerebrovascular involvement, remain unclear.

Purpose of the Study:

• To assess cerebrovascular function in PHPT patients.
• To determine if parathyroidectomy (PTX) improves cerebrovascular and cognitive function.
• To investigate the association between parathyroid hormone (PTH) levels, cerebrovascular function, and cognitive performance.

Main Methods:

• An observational study involving 43 patients with mild PHPT or goiter.
• Baseline assessment of cerebrovascular function (dynamic cerebral autoregulation, vasomotor reactivity) and neuropsychological function using transcranial Doppler.
• Comparison of pre- and post-operative (6 months) function in patients undergoing PTX or thyroidectomy.

Main Results:

• Cerebrovascular and neuropsychological function were comparable between PHPT and control groups preoperatively.
• Higher PTH levels correlated with poorer intracerebral autoregulation and cognitive performance.
• Post-PTX, mood significantly improved but not differently compared to thyroidectomy; no consistent cognitive or vascular improvements were observed in either surgical group.

Conclusions:

• Mild PHPT is not associated with impaired cerebrovascular or cognitive function.
• Parathyroidectomy does not consistently improve vascular or cognitive function in PHPT.
• While higher PTH is linked to poorer cerebral autoregulation, current findings do not support expanding PTX criteria for cognitive complaints, though further research in severe PHPT is warranted.