An Analysis of Primary Hyperparathyroidism in Association with Depression or Anxiety.

IF 2.9 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
Ana-Maria Gheorghe, Claudiu Nistor, Aurelian-Emil Ranetti, Mara Carsote
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引用次数: 0

Abstract

Background: Non-classical manifestations such as neuropsychiatric manifestations in primary hyperparathyroidism (PHPT) have long been documented as symptoms of PHPT and are commonly reported by these patients, despite this connection still being a matter of debate, and they (per se) do not represent an indication of parathyroidectomy.

Objective: We aimed to overview the most recent findings regarding the link between depression and/or anxiety (D/A) in subjects confirmed with PHPT, including the impact of the surgery in improving their outcome.

Methods: This was a comprehensive review of English-based original studies published between January 2020 and October 2024.

Results: The studies (n = 16) included a total of 10,325 patients and an additional 152,525 patients with hypercalcemia (out of whom 13,136 had a PHPT diagnosis and 45,081 were at risk of PHPT diagnosis). Out of these subjects with PHPT, 10,068 underwent parathyroidectomy. Female prevalence was between 62.5 and 92%. Most individuals were over 50, with the youngest studied population having a mean age of 52.7 ± 13.8 years, and the oldest had a median of 71. Depression was documented based on ICD-10 codes (n = 3) and patients' records (n = 2), Depression Anxiety Stress Scales (DASS) (n = 2), Beck Depression Inventory (BDI) (n = 3), BDI-II (n = 3), Symptom Check List 90-revised (SCL) (n = 1), Hamilton Depression Rating Scale (HAM-D) (n = 2), HADS (n = 2), Patient Health Questionnaire-9 (n = 1), and European Quality of Life 5 Dimensions 3-Level Version (EuroQOL-5D-3L) (n = 1). Patient records' (n = 1) and ICD-10 codes (n = 2) were also used for anxiety. Most studies used questionnaires to identify anxiety in PHPT: DASS (n = 2), SCL90R (n = 1), Generalized Anxiety Disorder-7 (n = 1), HADS (n = 2), EuroQOL-5D-3L (n = 1), and State-Trait Anxiety Inventory (n = 1). Depression prevalence varied from 20-36.6% to 65.7% (scale-based assessment) and to 10.5% upon ICD-10. A rate of newly onset depression was reported of 10.7% and of 0.2% with concern to the prevalent suicidal ideation (an incidental rate of 0.4% after a median follow-up of 4.2 years). Most studies identified a moderate depression (when assessing its severity), affecting approximately one third of the surgery candidates. The prevalence of anxiety in PHPT varied between 10.4% and 38.6% (n = 8). Discordant results were generated when applying distinct questionnaires for the same population, and this might come as a potential bias. Other confounding factors are generated by the sub-population referred for surgery that typically displays a more severe parathyroid condition or non-endocrine overlapping conditions (e.g., related to the social or familial status).

Conclusion: The modern approach of the patient with PHPT should be complex and go beyond the traditional frame. D/A had a high prevalence in the mentioned studies, associated with increased medication use. Yet, the underlying pathogenic mechanisms remain incompletely elucidated. No correlations between D/A and serum calcium levels were confirmed, while PTH had a slight positive correlation with depression. Parathyroid surgery appears to be beneficial for D/A as it improves the scores, prevalence, and severity. Cinacalcet might reduce depression scores, although more evidence is needed. Women are prone to both PHPT and D/A. The optimal method of D/A screening in PHPT remains to be determined, and the current scales need validation and perhaps adjustment for this specific population sub-group, while PHPT management should be refined upon D/A identification.

原发性甲状旁腺功能亢进伴抑郁或焦虑的分析。
背景:原发性甲状旁腺功能亢进(PHPT)的非典型表现,如神经精神表现,长期以来一直被认为是PHPT的症状,并且这些患者经常报告,尽管这种联系仍然存在争议,而且它们(本身)并不代表甲状旁腺切除术的指征。目的:我们旨在概述抑郁症和/或焦虑症(D/A)之间联系的最新发现,包括手术对改善其预后的影响。方法:这是对2020年1月至2024年10月期间发表的以英语为基础的原始研究的综合综述。结果:研究(n = 16)共纳入10,325例患者和152,525例高钙血症患者(其中13,136例诊断为PHPT, 45,081例有PHPT诊断风险)。在这些PHPT患者中,10068人接受了甲状旁腺切除术。女性患病率在62.5%至92%之间。大多数个体年龄在50岁以上,最年轻的研究人群平均年龄为52.7±13.8岁,最年长的研究人群平均年龄为71岁。根据ICD-10代码(n = 3)和患者记录(n = 2)、抑郁焦虑压力量表(DASS) (n = 2)、贝克抑郁量表(BDI) (n = 3)、BDI- ii (n = 3)、症状检查表90-修订版(SCL) (n = 1)、汉密尔顿抑郁评定量表(HAM-D) (n = 2)、HADS (n = 2)、患者健康问卷-9 (n = 1)、和欧洲生活质量5维度3级版本(EuroQOL-5D-3L) (n = 1)。患者记录(n = 1)和ICD-10代码(n = 2)也用于焦虑。大多数研究使用问卷来确定PHPT中的焦虑:DASS (n = 2)、SCL90R (n = 1)、广泛性焦虑障碍-7 (n = 1)、HADS (n = 2)、EuroQOL-5D-3L (n = 1)和状态-特质焦虑量表(n = 1)。抑郁患病率从20-36.6%到65.7%(基于量表的评估),在ICD-10中为10.5%。据报道,新发抑郁症发生率为10.7%,与流行的自杀意念有关的发生率为0.2%(中位随访4.2年后偶发率为0.4%)。大多数研究确定了中度抑郁症(在评估其严重程度时),影响了大约三分之一的手术候选人。PHPT患者的焦虑患病率在10.4%和38.6%之间变化(n = 8)。当对同一人群使用不同的问卷时,产生了不一致的结果,这可能是一个潜在的偏差。其他混杂因素是由转介手术的亚人群产生的,这些亚人群通常表现出更严重的甲状旁腺疾病或非内分泌重叠疾病(例如,与社会或家庭地位有关)。结论:PHPT患者的现代治疗方法应是复杂的,应超越传统的框架。在上述研究中,D/A的患病率很高,与药物使用增加有关。然而,潜在的致病机制仍未完全阐明。D/A与血清钙水平无相关性,而PTH与抑郁有轻微正相关。甲状旁腺手术似乎对D/A有益,因为它可以改善评分、患病率和严重程度。Cinacalcet可能会降低抑郁评分,尽管还需要更多的证据。女性更倾向于PHPT和D/A。PHPT中D/A筛查的最佳方法仍有待确定,目前的量表需要对这一特定人群进行验证和调整,而PHPT的管理应根据D/A的识别进行改进。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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