Related Experiment Video
Updated: May 4, 2026
06:08
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
26.6K
Middle-aged man with primary hyperparathyroidism-associated psychosis: A case report
Kota Shinkawa1,2, Masaya Mashimoto3, Toshio Matsubara1
1Department of Neuroscience, Division of Neuropsychiatry Yamaguchi University Graduate School of Medicine Ube Japan.
PCN Reports : Psychiatry and Clinical Neurosciences
|January 28, 2025
Summary
Primary hyperparathyroidism (PHPT) can cause psychosis even with mild hypercalcemia. Surgical treatment, not just medical management, may be necessary to resolve psychiatric symptoms in PHPT patients.
Area of Science:
- Endocrinology
- Psychiatry
- Neurosurgery
Background:
- Primary hyperparathyroidism (PHPT) with mild hypercalcemia is often asymptomatic.
- PHPT can manifest with psychiatric symptoms like depression, cognitive dysfunction, and psychosis, particularly in older adults.
Purpose of the Study:
- To highlight the importance of considering PHPT in patients presenting with psychosis, regardless of age or calcium levels.
- To emphasize the potential need for surgical intervention in PHPT cases unresponsive to medical treatment.
Main Methods:
- Case presentation of a 48-year-old male with new-onset psychosis and mild hypercalcemia.
- Diagnostic workup revealing Primary hyperparathyroidism (PHPT).
- Evaluation of treatment response to both medical management and surgical intervention.
Main Results:
- The patient presented with delusions and was diagnosed with PHPT.
- Medical treatment for mild hypercalcemia only partially improved disorientation, with psychiatric symptoms persisting.
- Surgical intervention led to complete resolution of delusions and sustained symptom remission without antipsychotics.
Conclusions:
- PHPT should be considered in the differential diagnosis of psychosis, even with mild hypercalcemia.
- Surgical treatment is a viable and effective option for PHPT patients with persistent psychiatric symptoms unresponsive to medical management.
Related Concept Videos
01:25Hyperthyroidism I: Introduction
30
Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
30
01:27Hyperthyroidism II: Pathophysiology
28
Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH...
28
01:28Graves' Disease I: Introduction
23
Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence...
23
01:24Graves Disease II: Pathophysiology
26
Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor,...
26
01:23Hypothyroidism II: Pathophysiology
26
Hypothyroidism is a disorder characterized by insufficient production of thyroid hormones, which regulate metabolism, energy balance, and multiple organ systems.TypesHypothyroidism is classified based on the level of dysfunction. Primary hypothyroidism results from intrinsic thyroid gland dysfunction, causing reduced hormone production despite normal or increased stimulation. Secondary hypothyroidism arises from inadequate thyroid-stimulating hormone (TSH) secretion by the pituitary. Tertiary...
26
01:19Cushing Syndrome II: Pathophysiology
24
Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features...
24