Acute confusional state as the presenting feature of primary hyperparathyroidism
Keywords:
primary hyperparathyroidism, confusional states, hypercalcemia, psychiatric manifestationsAbstract
Severe neuropsychological syndromes have been
previously described in association with primary hyperparathyroidism. The aetiopathogenic mechanisms underlying these rare neurological manifestations remain to be elucidated, as well as the
best therapeutic options, in such cases. We report
the clinical case of a 68-year-old woman, who was
admitted to the hospital because of an acute
confusional state, in whom initial clinical investigation revealed severe hypercalcemia. Confusion persisted after correction of the calcium levels and a diagnosis of primary hyperparathyroidism was
subsequently established on detection of elevated
levels of serum parathyroid hormone. The patient
underwent parathyroidectomy with a progressive
remission of the neuropsychiatric manifestations.
This case illustrates an extremely rare presenting
form of primary hyperparathyroidism, consisting in
an acute confusional syndrome that persisted after
correction of hypercalcemia and that remitted only
after surgical treatment of the disease. A brief review
of the mechanisms involved in the aetiopathogenesis
of the neuropsychological manifestations of primary
hyperparathyroidism is presented.
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