Neuropsychiatric Disorders in Primary Hyperparathyroidism

Endocrine disorders are being more frequently recognized as causes for significant mental and neuromuscular manifestations, which often dominate the clinical picture. Among these endocrinopathies hyperthyroidism, myxedema, diabetes mellitus hyperinsulinism, Cushing's disease, Addison's disease, and hypoparathyroidism have received greater attention in the literature from this point of view than has primary hyperparathyroidism (PHPT). In the majority of patients with PHPT, the prominent symptomatology which arouses suspicion for the diagnosis is not in the realm of psychiatry or neurology. However, in our experience, appreciable subjective and objective neuropsychiatric signs and symptoms have been found which were helpful in developing and confirming the clinical suspicion of hyperparathyroidism. In addition, we have encountered cases of PHPT where the presenting clinical picture was primarily psychiatric or neurologic, which led to consultation with a psychiatrist or neurologist before the true diagnosis was entertained. In view of the characteristic disturbances of calcium (and also magnesium) homeostasis