Hypercalcaemia: mild primary hyperparathyroidism may cause psychiatric symptoms and loss of bone density

Clinical bottom line (level 4)

  1. Patients with mild hypercalcaemia due to primary hyperparathyroidism probably have more psychiatric symptoms than controls, and probably have lower bone density
Okamoto et al: Endocrine Journal 1997; 44 (3): 367-374
Expires November 2004

The study

Systematic review of all studies of
  • Patients: primary hyperparathyroidism and mild hypercalcaemia (< 3.0 mmol/l)
  • Outcome: psychiatric disturbance, constipation, polyuria, joint pain,weight loss or bone mineral density


    • Articles found in English using Medline and PsycINFO, 1966 to 1995 (search terms: hyperparathyroidism or hypercalcemia, asymptomatic or mild or minimally symptomatic, mental disorders or psychiatric symptoms, constipation or bowel habits or bowel movements, polyuria or nocturia, joint pain or arthralgia, weight loss and bone density ) and searching reference lists in retrieved articles and textbooks

    Selection criteria: see above
    Appraisal criteria: criteria developed by Sackett et al
    Articles excluded if: not given

    7 studies found: 3 case-control addressing psychiatric symptoms involving 145 patients, and 4 cross-sectional studies on bone density involving 197 patients.

    The evidence

    • 2 studies found an increase in psychiatric symptoms in patients with mild hypercalcaemia (effect size 1.2-1.6)
    • All 4 studies on bone density reported a significant reduction (mean Z score -0.9 to -1.4)

    Comments

    1. Limiting the search to only English language articles may mean relevant material has been missed.
    2. There are too few patients from studies with serious methodological flaws to be confident about these results.
    3. No studies reported the presence of osteitis fibrosa cystica or renal stones.

    Citation

    1. Okamoto T, Gerstein HC, Obara T, et al: Psychiatric symptoms, bone density and non-specific symptoms in patients with mild hypercalcemia due to primary hyperparathyroidism: a systematic overview of the literature. Endocrine Journal 1997; 44 (3): 367-374
    Search Terms:
    Contributor: Chris Ball and Musab Hayatli, November 1999
    Reviewer:

    Clinical Question.
    Patient
    Intervention or Exposure
    Outcome