An Atypical Presentation of Primary Hyperparathyroidism in an Adolescent: A Case Report of Hypercalcaemia and Neuropsychiatric Symptoms Due to a Mediastinal Parathyroid Adenoma.

Psychiatric disorders are rare clinical manifestations of hypercalcaemia in the pediatric population, are relatively more frequent during adolescence and are often overlooked in cases of severe hypercalcaemia. We described the case of a 17-year-old girl affected by anorexia nervosa, depression and self-harm with incidental detection of moderate hypercalcaemia. Clinical, laboratory and instrumental tests demonstrated that hypercalcaemia was secondary to primary hyperparathyroidism (PHPT) due to a mediastinal parathyroid adenoma in the thymic parenchyma. After parathyroidectomy with robot-assisted surgery, we observed the restoration of calcium and PTH levels in addition to an improvement in psychiatric symptoms. This case demonstrates that serum calcium concentration should be evaluated in adolescents with neurobehavioural symptoms and in cases of hypercalcaemia PHPT should be excluded. Surgery represents the cornerstone of the management of PHPT and may contribute to improving quality of life and psychological function in these patients. However, the complexity of neurological involvement in cases of hypercalcaemia due to PHPT requires further investigations to establish the real impact of this condition on the neurocognitive sphere.

Transcranial Direct Current Stimulation (tDCS) in a Patient with PRES and Bipolar Depression.

Transcranial direct current stimulation (tDCS) is a non-invasive tool for brain stimulation and has proven efficacy in depressive disorders. Here, we report the case of a patient with recurrent bipolar depressive disorder and neurologic complications due to posterior reversible encephalopathy syndrome (PRES) due to parathyroid adenoma. During a long-term hospital stay, multiple drug regimens did not resolve depressive symptoms. Finally, an add-on therapy with tDCS brought improvement of symptoms. This case highlights the feasibility of tDCS in treatment-resistant depression and concomitant neurologic disorder.

[Chronic musculoskeletal pain syndrome in primary hyperparathyroidism]. / Chronisches muskuloskelettales Schmerzsyndrom bei primärem Hyperparathyreoidismus.

Chronic somatic pain disorders with somatic and mental factors (ICD-10: F45.41) are common among psychosomatic patients. In the present case, due to the close temporal association with a trauma and the subsequent development of symptoms including depressive symptoms, a chronic pain disorder with a relevant somatoform component was suspected. However, after a period of several months without significant somatic findings, targeted diagnostic approaches resulted in the diagnoses of primary hyperparathyroidism and a papillary thyroid carcinoma. Surgical therapy resulted in an almost complete decline of symptoms within a short period of time.

[Psychiatric disorders in elderly patients caused by disturbed calcium metabolism]. / Ausgeprägte Störungen des Kalziumstoffwechsels als Ursache psychischer Störungen bei Alterspatienten.

We report on three patients admitted to psychiatric hospital due to mental disorder in the context of marked pathology of calcium metabolism: a 69 years old male patient with known major depression developed pronounced deterioration of his mental state with distinct hypercalcemia due to parathyroid adenoma, a 90 years old male patient came to treatment with organic affective und delirious symptomatology caused by severe hypercalcemia due to bronchial carcinoma, and a 79 years old female patient was admitted for mixed depressive and anxiety syndrome with profound hypocalcemia and -magnesaemia originating in malabsorption syndrome due to Crohn's disease. Although all patients had received general medical care previously the relevance of their metabolic disorders with regard to their psychopathology had not been ascertained. In all cases treatment of disturbed electrolyte metabolism resulted in an at least temporary improvement of their psychiatric symptomatology. Our case reports referring to elderly patients with multimorbidity underscore the etiological relevance of disturbed calcium metabolism with regard to a broad spectrum of psychiatric syndromes.

Psychosocial consequences of DNA analysis for MEN type 2.

Multiple endocrine neoplasia type 2 (MEN-2) is characterized by medullary thyroid carcinoma in combination with pheochromocytomas and, sometimes, parathyroid adenomas. Since 1993, the psychosocial implications of DNA analysis for MEN-2 have been studied in the Netherlands. This article summarizes the first results of that study. Individuals who applied for DNA analysis cited the need to reduce uncertainty as the major reason for wanting the test. An unfavorable test outcome resulted in anxiety and depression but also relief. Immediate preventive treatment was preferred to continued periodic screening. Carriers were preoccupied with disease-related complaints, and identified with other carriers and MEN-2 patients. A favorable test led, in most applicants and partners, to both relief and worry. Some noncarriers felt guilty and isolated from their families. One year after counseling, participants reported fewer psychosomatic complaints.

Primary hyperparathyroidism, hypercalcemia, paranoid delusions, homicide, and attempted murder.

This report describes a case of primary hyperparathyroidism in a 68-year-old man. The endocrine disorder, while suspected before the commission of homicide and attempted murder, was proven biochemically and histologically a number of months after the commission of the crimes. The acts of homicide and attempted murder followed the development of paranoid delusions, which rapidly resolved upon successful removal of a single cystic parathyroid gland adenoma. The unusual events that immediately followed the acts of violence indicate that the delusions occurred in a clear sensorium (absence of delirium). Psychological measures taken before and after surgery document improvement in subtle organic functioning while intelligence was unchanged. This report discusses the neuropsychiatric manifestations of hypercalcemia and reviews the literature.