A Review of the Relationship of the Cerebrospinal Fluid Changes During the Dysregulation of Parathyroid Hormone With Psychiatric or Neurological Manifestations

Abstract

It is established that normal calcium and vitamin D concentrations are maintained in the body through parathyroid hormone (PTH), a signaling molecule secreted from parathyroid glands. A massive role is played by PTH in increasing calcium levels when they are extremely low in the body through different mechanisms. The dysregulation of this hormone is due to either over functioning of the gland (hyperparathyroidism) or compromised functioning in hypoparathyroidism. A detailed review was done to identify if any changes are happening in the cerebrospinal fluid (CSF) due to any pathology causing the parathormone to be dysregulated enough to, in turn, cause any further pathology in the nervous system. This may then lead to various disabling neuropsychiatric features. The calcium and vitamin D abnormalities are both directly and indirectly connected to psychiatric features like delusions, schizophrenia, disabled cognition, psychosis, coma, mania, and depression of all kinds. Moreover, their irregularities are also linked to Alzheimer's. During these manifestations, the CSF is altered concentration-wise, where elevated calcium levels inside are observed during different studies. Despite PTH's indirect connection to the CSF modifications, their association hasn't been potently proven yet, considering more observational studies should be conducted in humans and for a more extended period, along with bigger and greater numbers of CSF samples. Suppose there is a possibility of the link of CSF alterations to PTH. In that case, we can consider a pronounced increase of CSF calcium or PTH as a risk factor for debilitating neuropsychiatric diseases. In this review, the possible correlation of CSF and PTH has been discussed.

Keywords: calcium & schizophrenia; calcium/cerebrospinal fluid"[mesh]; cerebrospinal fluid/physiology"[mesh]; csf & psychosis; csf & pth; parathyroid hormone/cerebrospinal fluid"[mesh]; psychiatry/physiology"[mesh]; pth & psychosis; vitamin d & depression.

Figure 1. The parathyroid gland due to any sort of calcium imbalance, switches on the negative feedback mechanism, which in turn releases PTH to normalize the concentration of calcium in the body.

In addition to increasing the calcium during its deficiency, PTH also decreases phosphate, regulates the growth of fibroblast and, acts on bones, kidneys and, intestines. However, Vitamin D's major source is UVB radiation and dietary sources. PTH: parathyroid hormone; UVB: ultraviolet B radiation.

Figure 2. The release of parathormone from the parathyroid gland, synthesizes vitamin D, which in turn produces TPH2.

This enzyme is responsible for the conversion of tryptophan into serotonin.

Figure 3. Due to little or no serotonin formed, because of the cessation of tryptophan's conversion in the brain, an affected individual's mental health starts compromising.

Along with a defective mental state, there is altered cognition and faulty sensory gaiting. Furthermore, in terms of behavior, the patient experiences impulsiveness, outbursts, aggression, and manic episodes.