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Endocrine Surgery

(471) Systematic Review: Perioperative Neurocognitive Function Testing in Patients Undergoing Parathyroidectomy

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Danielle A. Morrison, MD

    Resident Physician
    Walter Reed National Military Medical Center/
    Bethesda, Maryland, United States

  • Grace C. Baisden, MD

    Intern
    Walter Reed National Military Medical Center
    Bethesda, Maryland, United States

    • Co-Author(s)

  • Alex Otto, DO

    PGY1
    University of New England College of Osteopathic Medicine
    Hoboken, New Jersey, United States

  • Om Chitnis, BS

    Medical Student
    Uniformed Services University of the Health Sciences
    Rockville, Maryland, United States

    • Senior Author(s)

  • MO

    Michael I. Orestes, MD

    Program Director
    Walter Reed National Military Medical Center - Otolaryngology Department
    Bethesda, Maryland, United States

Disclosure(s):
Danielle A. Morrison, MD: No relevant relationships to disclose.
Grace C. Baisden, MD: No relevant relationships to disclose.
Alex Otto, DO: No relevant relationships to disclose.
Om Chitnis, BS: No relevant relationships to disclose.
Michael I. Orestes, MD: No relevant relationships to disclose.


Introduction: Neurocognitive impairment is a well described symptom of primary hyperparathyroidism. However, standardized perioperative neurocognitive assessments are not used to determine indications for surgical intervention. This systematic review aims to explore the use of neurocognitive testing and its relationship to outcomes after parathyroidectomy in patients with primary hyperparathyroidism.

Methods: PRISMA guidelines were utilized to identify English-language studies between December 1984 and December 2022 reporting pre and post operative neurocognitive testing in patients with primary hyperparathyroidism undergoing parathyroidectomy. Primary outcomes included neurocognitive assessments and laboratory testing.

Results: Systematic review identified 78 studies with 1922 patients for qualitative analysis. A total of 98 different neurocognitive tests were used with the following showing statistically significant improvement post-operatively: health related quality of life, trail making test, Wechsler Adult Intelligence Scale, Hamilton depression rating scale, PHQ-9, Rey Auditory Verbal Learning Test, Hopkins Verbal Learning Test, Visual analog scale. There were no significant associations between neurocognitive testing and biochemical/laboratory assays.

Conclusions: Development of standardized neurocognitive testing in patients with primary hyperparathyroidism could assist in guiding surgical decision making in patients that do not otherwise meeting criteria for parathyroidectomy. Out of the numerous neurocognitive tests reviewed in this study, a few showed significant association with post-operative outcomes. Further analysis and improved use of these neurocognitive assessments can lead to development of clearer surgical criteria.