The case of a 76-year-old female patient is presented with a two-year
history of progressive dementia, apathy and gait impairment. Initially,
Alzheimer’s disease was diagnosed and she was given donepezil for one
year with no significant improvement. An extensive blood and biochemical
control revealed high serum calcium and parathormone levels, and normal
thyroid hormones and anti-thyroid antibodies. Ultrasound of thyroid and
parathyroid glands revealed an adenoma of the right parathyroid. The
detailed investigation for causes of secondary hyperparathyroidism was
negative. Due to the absence of clinical hyperparathyroidism she was
initially treated conservatively. At referral, the neurological picture
consisted of. mild signs of parkinsonism, moderate dementia (MMSE = 15)
and severe behavioural disturbances. Because of the continuous
aggravation of the cognitive deficit, parathyroidectomy was decided
although there were no clinical or laboratory signs of involvement from
other organs. Three weeks after the operation the neurological picture
showed dramatical improvement. Parkinsonism and behavioural disorders
were remarkably reduced and the MMSE score raised to 25.
In summary we report an exceptional case of primary hyperparathyroidism
(PHPT) presenting as dementia and treated successfully by
parathyroidectomy. (C) 2008 Elsevier B.V. All rights reserved
