Functional MRI Imaging for Parathyroid Disease
Research type
Research Study
Full title
Glutamate Dysregulation and Cognitive Dysfunction in Primary Hyperparathyroidism: In Vivo Detection Using Magnetic Resonance Spectroscopy
IRAS ID
324198
Contact name
Tarek Abdel-Aziz
Contact email
Sponsor organisation
University College London Hospital Trust
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder following thyroid disease and diabetes. Its incidence is rising globally with a UK incidence of 25/100,000 and a prevalence that has risen from 1.8 to 6.7/1000 between 1997 and 2006. The most common modern presentation is cognitive dysfunction, sleep disturbance, anxiety, irritability and memory disorders. These are not metrically quantified and therefore do not constitute an indication for treatment. A result is a growing number of patients with normocalcaemic PHPT (nPHPT) struggling with such symptoms. Several patient groups are calling for a change in guidelines to allow for treatment of these patients.
It has been shown that patients with nPHPT have more emotional problems, worse social functioning and a decreased health perception when compared to patients with symptomatic PHPT with a significant improvement in social functioning and emotional disturbances following surgery.
It is hypothesized that high levels of parathyroid hormone which cross the blood-brain barrier cause high intracellular calcium levels leading to a state of localised and exaggerated energy expenditure.
A recent report investigating a neuro-metabolic account of cognitive fatigue through using fMRI showed that concentrations of glutamate were higher in areas of the brain of groups performing high-demand tasks when compared to low-demand tasks. Glutamate is released in the brain in response to increased calcium levels. The hypothesis is that glutamate release in the brain and/or the disruption of the mechanisms to eliminate glutamate in patients with PHPT is responsible for the cognitive dysfunction in this group of patients who do not exhibit other classical manifestations of PHPT.
This study will determine if a higher level of glutamate is present in patients with primary hyperparathyroidism and assess cognitive dysfunction in patients with a biochemical diagnosis of primary hyperparathyroidism undergoing clinically indicated parathyroidectomy (surgical removal of one or more parathyroid glands) through establishing a correlation between glutamate levels, as determined by use of functional magnetic resonance imaging (fMRI), and cognitive symptoms, utilising the Montreal Cognitive Assessment Questionnaire.
REC name
West Midlands - Edgbaston Research Ethics Committee
REC reference
25/WM/0271
Date of REC Opinion
27 Jan 2026
REC opinion
Further Information Favourable Opinion