Prospective, randomized, controlled trial of parathyroidectomy versus observation in patients with “asymptomatic” primary hyperparathyroidism
Accepted 25 September 2009. published online 02 November 2009.
Background
Disruptions in cognitive function have been described in the constellation of symptoms associated with “asymptomatic” primary hyperparathyroidism (PHPT). The aim of this study was to determine the impact of parathyroidectomy (PTX) on brain function and sleep in “asymptomatic” PHPT patients.
Methods
We conducted a prospective, randomized trial comparing immediate PTX with observation in patients with asymptomatic PHPT. We performed functional magnetic resonance imaging (fMRI) of the brain, sleep assessment, and validated neuropsychological battery at baseline, 6 weeks, and 6 months. Wilcoxon rank-sum and Pearson and Spearman correlations were used.
Results
A total of 18 patients were randomized. Subjective sleepiness correlated with worse performance on executive function tests during fMRI at 6 weeks (Pearson, −0.473; P = .047) and 6 months (Pearson, −0.673; P = .002). Total sleep time correlated with PTH levels at both 6 weeks (Pearson, 0.518; P = .048) and 6 months (Pearson, 0.567; P = .018). At 6 weeks, hypersomnolence as measured subjectively was decreased in the PTX group, but increased in those observed (−2.56 vs 2.22; P = .03)
Conclusion
This prospective, randomized trial for asymptomatic PHPT patients demonstrated an association of sleep with brain function. Sleep seemed to be an indicator of brain activation in the anterior cingulate gyrus and precentral cortex. Subjective sleepiness was associated with executive function. The results of this pilot study suggest that decreased serum PTH levels correlate with improved sleep and that PTX decreases sleepiness in patients with asymptomatic PHPT.
aDepartment of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
bDepartment of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX
cDepartment of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
dDepartment of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, TX
eDepartment of Rehabilitation/Physical Therapy, The University of Texas M. D. Anderson Cancer Center, Houston, TX
fDepartment of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
gDepartment of Imaging Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Reprint requests: Nancy D. Perrier, MD, Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402.
Funded by the American Geriatric Society, Jahnigan Career Development Award
ABSTRACT