Serum cortisol and osteocalcin levels may be associated with symptoms of anxiety and depression in patients with primary hyperparathyroidism, according to research results published in Frontiers in endocrinology.
To date, the relationships between changes in cortisol and osteocalcin concentrations in primary hyperparathyroidism, as well as their relationships and psychological characteristics in this patient population, have not been evaluated. To solve this problem, the researchers analyzed the potential interaction between these hormones and emotional health.
Psychological questionnaires were administered between August 2020 and December 2020 and obtained for 38 of the 52 patients. Between 2011 and 2020, 192 patients – including 38 with completed questionnaires – were retrospectively assessed. Patients who met the inclusion criteria were included in the present study.
Because only 38 patients received a psychological assessment, the researchers performed a sensitivity analysis between patients who took these tests and those who did not. The results indicated that there was no difference between the groups in terms of age, sex, duration of illness, weight or height, body mass index (BMI), systolic blood pressure, heart rate, bone mineral density (BMD), serum parathyroid hormone (PTH) concentration, vitamin D, albumin, glycated hemoglobin and phosphorus. Serum calcium concentration, however, was higher in these patients.
Short Form Survey (SF-36) mental component scores were 74.04 ± 23.32 for social function, 72.74 ± 18.71 for mental health, 57.76 ± 22.17 for vitality and 66.67 (range, 0-100) for the role of emotion. The State-Trait Anxiety Inventory-State (STAI-S) score was 35.43 ± 11.56, the STAI-Trait (T) score was 37.39 ± 10.34, and the Beck Depression Inventory (BDI) score was 5 (range, 0-46). Of the 38 patients who completed the questionnaires, 50% with a STAI-S score of 32.2 or higher were in a state of anxiety, while 60.5% of those with a STAI-T score of 31.8 or more have developed anxiety.
The researchers also assessed the association between serum concentrations of PTH, calcium, osteocalcin and cortisol with psychological performance. Results from a bivariate model indicated that cortisol concentration at 8:00 a.m. was “significantly and negatively correlated” with social function. Serum osteocalcin concentration was also significantly and negatively correlated with BDI, while serum PTH and calcium were not correlated with any questionnaire score. After controlling for age, sex and duration of illness, the correlation of cortisol remained true.
Further adjustments for PTH, vitamin D, phosphorus, and calcium showed a significant and continuing negative correlation with 8:00 a.m. cortisol and social function score.
The researchers found that osteocalcin was associated with PTH and was marginally associated with calcium; cortisol was not associated with any of these parameters.
Further testing was done to see if the results could be reproduced in a larger sample size. The researchers evaluated the relationships between osteocalcin, cortisol, PTH and calcium in a group of 192 patients with primary hyperparathyroidism. The mean age of this cohort was 52.7 ± 13.8 years; 76.6% were women.
The results indicated that in terms of bone biochemical markers, serum concentrations of calcium, type I procollagen amino-terminal peptide (PINP) and collagen I-b-telopeptide (b-CTX) were all increased, while that phosphorus was significantly decreased. The percentage of patients in the upper tertile of osteocalcin concentration also increased with an increase in PTH concentration, while serum vitamin D and BMD levels each decreased significantly.
When grouping patients by serum tertile calcium concentration, serum PTH, PINP, b-CTX and the percentages of patients with osteocalcin concentration in the upper tertile were all significantly increased, while serum phosphorus and BMD were significantly reduced.
The results of a bivariate correlation model between serum PTH, osteocalcin and cortisol concentration showed that serum PTH was both positively and significantly correlated with serum osteocalcin; after controlling for age, sex and disease duration, the correlation of PTH with serum osteocalcin concentration was still positive and significant.
Limitations of the study included lack of comparison between postoperative and preoperative serum concentrations and psychological questionnaires, small sample size, potential for selection bias, and a lack of measurement of body water distribution. in patients treated with fluid repletion.
“In this study, it was shown that serum levels of [osteocalcin] and cortisol have been independently associated with the development of psychological symptoms in [patients with primary hyperparathyroidism]”, the researchers concluded.” More basic and clinical studies are needed to test and verify this observation. “
Wang SM, He Y, Zhu MT et al. Associations of serum osteocalcin and cortisol levels with psychological performance in patients with primary hyperparathyroidism. Endocrinol before. 2021; 12: 692722. doi: 10.3389 / fendo.2021.692722