Hiperparatireoidismo simulando doença de Creutzfeldt-Jacob

Bertolucci, Paulo H. F.; Malheiros, Suzana F.

doi:10.1590/S0004-282X1990000200019

Resumos

Uma mulher de 45 anos apresentou quadro de perda da iniciativa, dificuldade de memória, choro imotivado e distúrbio de comportamento, rapidamente progressivos ao longo de 6 meses, quando tornou-se não responsiva a estímulos verbais e totalmente apática. Um EEG mostrou atividade periódica bilateral, sugerindo doença de Creutzfeldt-Jacob (DCJ), mas a investigação para outras causas de demência mostrou hypercalcemia e hipofoefatemia que, exames posteriores, indicaram dever-se a adenoma de células oxífilas de paratireóide. Com a correção do distúrbio eletrolítico e posterior cirurgia houve normalização tanto do EEG como do exame neurológico. Não temos conhecimento de outros relatos de hiperparatireoidismo associado a síndrome demencial e atividade periodica no EEG. Este deveria ser am diagnóstico diferencial em todos os casos de DCJ recente.

A 45 years-old woman presented with loss of iniciative and memory, imotivated ciy and behaviour disturbance with childish traits, quickly progressive along 6 months until total apathy. An EEG showed periodic activity with bilateral triphasic waves against a flattened background activity suggesting Creutzfeldt-Jacob disease (CJD), but investigation for treatable causes of dementia disclosed hypercalcemia and hypophosphatemia. Further investigation showed a mass at the thyroid region that at surgery was identified as an oxyphilic ceils adenoma. With electrolyte disturbance correction and posterior surgery there was normalization of both EEG and clinical status. Though it was previously reported mental confusion and EEG alteration associated with hyperparathyroidism we do not know of any previous case o>: confusion associated with periodic activity in EEG as in this disease. Hyperparathyroidism should be a differential diagnosis in every «de novo» case of CJD.

Paulo H. F. Bertolucci; Suzana F. Malheiros

Disciplina de Neurologia, Escola Paulista de Medicina

RESUMO

Uma mulher de 45 anos apresentou quadro de perda da iniciativa, dificuldade de memória, choro imotivado e distúrbio de comportamento, rapidamente progressivos ao longo de 6 meses, quando tornou-se não responsiva a estímulos verbais e totalmente apática. Um EEG mostrou atividade periódica bilateral, sugerindo doença de Creutzfeldt-Jacob (DCJ), mas a investigação para outras causas de demência mostrou hypercalcemia e hipofoefatemia que, exames posteriores, indicaram dever-se a adenoma de células oxífilas de paratireóide. Com a correção do distúrbio eletrolítico e posterior cirurgia houve normalização tanto do EEG como do exame neurológico. Não temos conhecimento de outros relatos de hiperparatireoidismo associado a síndrome demencial e atividade periodica no EEG. Este deveria ser am diagnóstico diferencial em todos os casos de DCJ recente.

SUMMARY

A 45 years-old woman presented with loss of iniciative and memory, imotivated ciy and behaviour disturbance with childish traits, quickly progressive along 6 months until total apathy. An EEG showed periodic activity with bilateral triphasic waves against a flattened background activity suggesting Creutzfeldt-Jacob disease (CJD), but investigation for treatable causes of dementia disclosed hypercalcemia and hypophosphatemia. Further investigation showed a mass at the thyroid region that at surgery was identified as an oxyphilic ceils adenoma. With electrolyte disturbance correction and posterior surgery there was normalization of both EEG and clinical status. Though it was previously reported mental confusion and EEG alteration associated with hyperparathyroidism we do not know of any previous case o>: confusion associated with periodic activity in EEG as in this disease. Hyperparathyroidism should be a differential diagnosis in every «de novo» case of CJD.

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Dr. Paulo H. F. Bertolucci - Disciplina de Neurologia, Escola Paulista de Medicina - Rua Botucatu 740 - 04023 São Paulo SP - Brasil

1. Ball JH, Eutkus DE, Madison DS - Effect of subtotal parathyroidectomy on dyalisis dementia. Nephron 18:151, 1977.
2. Bertolucci 1'HF, Silva AB - Descargas epileptiformes periódicas lateralizadas: I. Aspectos clínicos e e'etrencefalograficos. Arq Neuro-Psiquiat (São Paulo) 45:364, 1987.
3. Chatrian GE. Shaw CM, Leffman H - The significance of periodic lateralized epileptiform discharges in E!EG: an electrographic, clinical and pathologic?.! study. Electroenceph Clin Neurophysiol 17:177, 1964.
4. Fischer-Williams M - Burst-suppression motivity as an indication of undercut cortex. Electroenceph Clin Neurophysiol 15:723, 1963.
5 Henson RA - The neurological aspects of hypercalcaemia: with special reference to primary hyperparathyroidism. J Roy Coll Physns 1:41, I960.
6. Joborn C, Hetta J, Frisk P, Palmer M, Akerstrom G, Ljunghall 9 - Primary hyperparathyroidism in patients with organic brain syndrome. Acta Med Stand 219:91, 1986.
7. Karpati G. Frame B - Neuropsychiatry disorders in primary hyperparathyroidism. Arch Neurol 10:387, 1964.
5. Kleinfeld M. Peter S, Gilbert GM - Delirium as the predomirant manifestation of hyperparathyroidism. J Am Geriat Soc 32:689, 1984.
9. Luxenberg J, Feigenbaum LZ, Aron JM - Reversible longstanding dementia with normocalceiimc hyperparathyroidism. J Am Geriat Soc 32:546, 1984.
10. Moure JMB - The electroencephalogram in hypercalcemia. Arch Neurol 17:34, 1967.
11 Patten BM, Engel WK - Phosphate and parathyroid disorders associated with the syndrome of amyotrophic lateral sclerosis. In Rowland LP (ed): Human Motor Neuron Diseases. Raven Press, New York, 1982, pg 181.
12. Patten BM, Pages M - Severe neurological disease associated with hyperparathyroidism. Ann Neurol 15:453. 1984.
13. Schmid H, Haller R, Konig P - Wertgkeit des EEG bei Nebenschilddrüsenstorungen und/oder symmetrischen Stammganglienverkalkungen (Farsches Syndrom). Wien Klin Wchsr 98:4f6, 1986.
14. Schwartz MS. Prior PF, Scott DF - The occurrence and evolution in the EEG of a lateralized periodic phenomenon. Brain 96:613, 1973.
15. Shore D, Wills MR, Savory J, Wyatt RJ - Serum parathyroid hormone concentration in senile dementia (Alzheimer's disease). J Gerontol 35:656, 1980.
16. Silva AB, Bertolucci PHF - Descargas epileptiformes periódicas lateralizadas: II. Aspectos evolutivos. Arq. Neuro-Psiquiat (São Paulo) 46:10, 1988.
17. Smits MG, Abreu RA. Froeling PGA, Gabreels FJM - Presence of cerebral parathyroid hormone-responsive adenylcyclase in humans. Ann Neurol 14:348, 1983.
18. Terzano MG, Parrino L. Mazzucchi A, Moretti G - Cojifusional states with periodic lateralized epileptiform discharges (PLEDs): a peculiar epileptic syndrome in the elderly. Epilepsia 27:446, 1986.
19. Trouillas P, Brudon F, Saubier M - Encéphalopathie parathyrotoxique sans hypercal-cémie. Rev Neurol 141:562, 1985.
20. Vieira JGEí, Oliveira MAD, Russo EMK, Maciel RMB, Pereira AB - Egg yolk as a source of antibodies for human parathyroid hormone (hPTH) radioimmunoassay. J Immunoassay 5:121, 1984.
21. Yanagihara R, Garruto RM, Gaidusek DC, Tomita A, TJchikawa Y, Chen KM, Sobue I, Plato CC, Gibbs CJ - Calcium and vitamin D metabolism in Guamanian chamorros with amyotrophic lateral sclerosis and parkinsonism-dementia. Ann Neurol 15:42, 1984.

Hiperparatireoidismo simulando doença de Creutzfeldt-Jacob

Hyperparathyroidism simulating Creutzfeldt-Jacob disease

Datas de Publicação

Publicação nesta coleção
25 Maio 2011
Data do Fascículo
Jun 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ball JH, Eutkus DE, Madison DS - Effect of subtotal parathyroidectomy on dyalisis dementia. Nephron 18:151, 1977.

[2] 2. Bertolucci 1'HF, Silva AB - Descargas epileptiformes periódicas lateralizadas: I. Aspectos clínicos e e'etrencefalograficos. Arq Neuro-Psiquiat (São Paulo) 45:364, 1987.

[3] 3. Chatrian GE. Shaw CM, Leffman H - The significance of periodic lateralized epileptiform discharges in E!EG: an electrographic, clinical and pathologic?.! study. Electroenceph Clin Neurophysiol 17:177, 1964.

[4] 4. Fischer-Williams M - Burst-suppression motivity as an indication of undercut cortex. Electroenceph Clin Neurophysiol 15:723, 1963.

[5] 5 Henson RA - The neurological aspects of hypercalcaemia: with special reference to primary hyperparathyroidism. J Roy Coll Physns 1:41, I960.

[6] 6. Joborn C, Hetta J, Frisk P, Palmer M, Akerstrom G, Ljunghall 9 - Primary hyperparathyroidism in patients with organic brain syndrome. Acta Med Stand 219:91, 1986.

[7] 7. Karpati G. Frame B - Neuropsychiatry disorders in primary hyperparathyroidism. Arch Neurol 10:387, 1964.

[8] 5. Kleinfeld M. Peter S, Gilbert GM - Delirium as the predomirant manifestation of hyperparathyroidism. J Am Geriat Soc 32:689, 1984.

[9] 9. Luxenberg J, Feigenbaum LZ, Aron JM - Reversible longstanding dementia with normocalceiimc hyperparathyroidism. J Am Geriat Soc 32:546, 1984.

[10] 10. Moure JMB - The electroencephalogram in hypercalcemia. Arch Neurol 17:34, 1967.

[11] 11 Patten BM, Engel WK - Phosphate and parathyroid disorders associated with the syndrome of amyotrophic lateral sclerosis. In Rowland LP (ed): Human Motor Neuron Diseases. Raven Press, New York, 1982, pg 181.

[12] 12. Patten BM, Pages M - Severe neurological disease associated with hyperparathyroidism. Ann Neurol 15:453. 1984.

[13] 13. Schmid H, Haller R, Konig P - Wertgkeit des EEG bei Nebenschilddrüsenstorungen und/oder symmetrischen Stammganglienverkalkungen (Farsches Syndrom). Wien Klin Wchsr 98:4f6, 1986.

[14] 14. Schwartz MS. Prior PF, Scott DF - The occurrence and evolution in the EEG of a lateralized periodic phenomenon. Brain 96:613, 1973.

[15] 15. Shore D, Wills MR, Savory J, Wyatt RJ - Serum parathyroid hormone concentration in senile dementia (Alzheimer's disease). J Gerontol 35:656, 1980.

[16] 16. Silva AB, Bertolucci PHF - Descargas epileptiformes periódicas lateralizadas: II. Aspectos evolutivos. Arq. Neuro-Psiquiat (São Paulo) 46:10, 1988.

[17] 17. Smits MG, Abreu RA. Froeling PGA, Gabreels FJM - Presence of cerebral parathyroid hormone-responsive adenylcyclase in humans. Ann Neurol 14:348, 1983.

[18] 18. Terzano MG, Parrino L. Mazzucchi A, Moretti G - Cojifusional states with periodic lateralized epileptiform discharges (PLEDs): a peculiar epileptic syndrome in the elderly. Epilepsia 27:446, 1986.

[19] 19. Trouillas P, Brudon F, Saubier M - Encéphalopathie parathyrotoxique sans hypercal-cémie. Rev Neurol 141:562, 1985.

[20] 20. Vieira JGEí, Oliveira MAD, Russo EMK, Maciel RMB, Pereira AB - Egg yolk as a source of antibodies for human parathyroid hormone (hPTH) radioimmunoassay. J Immunoassay 5:121, 1984.

[21] 21. Yanagihara R, Garruto RM, Gaidusek DC, Tomita A, TJchikawa Y, Chen KM, Sobue I, Plato CC, Gibbs CJ - Calcium and vitamin D metabolism in Guamanian chamorros with amyotrophic lateral sclerosis and parkinsonism-dementia. Ann Neurol 15:42, 1984.