2023-08-16 16:47:49
Title: Hyperparathyroidism May Be the Underlying Cause of Sleep Disorders in Some Patients
Introduction
Insomnia and sleep disorders can greatly affect one’s quality of life. While psychological issues are often considered as the primary cause of these disturbances, an intriguing case raises a question about the potential link between elevated parathyroid hormone levels and sleep disorders. In this article, we explore the case of a patient whose symptoms persisted despite psychotherapy, only to find a possible connection to hyperparathyroidism.
Case Presentation
A woman in her mid-30s sought medical help for her persistent insomnia. Despite being in psychotherapy for nine months, her condition showed no improvement. Further examination of her lab values revealed an abnormal parathyroid hormone level, twice the limit value. This prompted the medical professional to investigate if hyperparathyroidism could explain her sleep disorder.
Understanding Hyperparathyroidism
Hyperparathyroidism is a condition when the normal regulation of parathyroid hormone secretion is disrupted, often caused by an adenoma in the parathyroid glands. Primary hyperparathyroidism (pHPT) can lead to various symptoms, including kidney stones and bone resorption. However, patients with normocalcemic primary hyperparathyroidism (npHPT) have lower parathyroid hormone levels and may experience milder symptoms.
The Link Between Hyperparathyroidism and Sleep Disorders
While the exact mechanism is not fully understood, studies have shown that patients with primary hyperparathyroidism experience improved sleep quality after surgical removal of the affected parathyroid gland. This improvement suggests a potential connection between elevated parathyroid hormone levels and sleep disturbances. It is believed that dysfunction of the autonomic nervous system or the release of pro-inflammatory cytokines could contribute to these sleep disorders.
Diagnosis and Treatment
To diagnose hyperparathyroidism, a comprehensive assessment is required, including measuring serum calcium levels and phosphate levels. Additionally, bone density measurement, kidney ultrasound, and calcium excretion in the urine may also be performed to rule out related complications. Parathyroid surgery is the definitive treatment for both normocalcemic and hypercalcemic primary hyperparathyroidism.
Conclusion
While normocalcemic primary hyperparathyroidism is relatively understudied and often discovered incidentally, it is essential to consider this condition in cases of sleep disorders and unclear psychological symptoms. Medical professionals should be aware of the potential connection between elevated parathyroid hormone levels and sleep disturbances, offering comprehensive diagnostic evaluations and appropriate treatment options.
Although the diagnosis for the patient in this case could not be conclusively secured due to her decision to seek further evaluation in her home country, it highlights the importance of investigating less common causes for sleep disorders and seeking specialized care when necessary.
Sources:
1. Mittendorf EA et al.: Improvement of sleep disturbance and neurocognitive function after parathyroidectomy in patients with primary hyperparathyroidism. Endocr Pract 2007. doi: 10.4158/EP.13.4.338
2. La J et al.: Parathyroidectomy for primary hyperparathyroidism improves sleep quality: A prospective study. Surgery 2017. doi: 10.1016/j.surg.2016.05.047
3. Rasche RV et al.: Influence of Parathyroidectomy on Sleep Quality in Primary Hyperparathyroidism. Adv Exp Med Biol 2021. doi: 10.1007/5584_2021_628
4. Murray SE et al.: Improvement of sleep disturbance and insomnia following parathyroidectomy for primary hyperparathyroidism. World J Surg 2014.]
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