PSYCHIATRIC-SYMPTOMS, BONE-DENSITY AND NONSPECIFIC SYMPTOMS IN PATIENTS WITH MILD HYPERCALCEMIA DUE TO PRIMARY HYPERPARATHYROIDISM - A SYSTEMATIC OVERVIEW OF THE LITERATURE

To determine (1) the relationship between primary hyperparathyroidism with mild hypercalcemia and psychiatric disturbances, bone density, or non-specific symptoms, and (2) the effect of parathyroidectomy on the se outcomes, a systematic and critical review of the literature was co nducted. Relevant citations were identified using MEDLINE (1966 to Aug ust, 1995) and PsycINFO (1967 to August, 1995). Studies were included for the overview if they described patients with mild hypercalcemia (< 12 mg/dl), and if they dealt with at least one of the following outco mes: psychiatric disturbances, bone density, joint pain, constipation, polyuria/nocturia or weight loss. Either a calculated effect size or Z score was used to estimate the effect of the disease or parathyroide ctomy on these outcomes. Seven studies met the inclusion criteria for this overview. Two out of three case-control studies on psychiatric sy mptoms found a significant association between primary hyperparathyroi dism with mild hypercalcemia and psychiatric disturbances (effect size s; 0.17, 1.2 and 1.6). One of the three studies also examined the effe ct of parathyroidectomy on psychiatric symptoms, and found an effect s ize of 1.5. All four cross-sectional studies that measured bone mass s howed significantly reduced bone density in the forearm and the lumbar spine. The bone loss ranged from 0.9 to 1.4 standard deviation below the age- and sex-adjusted mean value in the forearm, and was 0.5 in th e spine. There was no relevant study regarding non-specific symptoms. Among the seven studies, five did not explicitly indicate whether the patients had classical symptoms of either osteitis fibrosa cystica or renal stones. Primary hyperparathyroidism with mild hypercalcemia is a ssociated with psychiatric disturbances and reduced bone density. Neve rtheless, further research is needed to determine the symptoms, partic ularly for a group of patients without either classical bone disease o r renal stones. The effects of parathyroidectomy on these outcomes als o remain to be determined.