A Case of Acute Psychosis in an Adolescent Male

Babar, Ghufran; Alemzadeh, Ramin

doi:10.1155/2014/937631

Cited by 10 publications

(11 citation statements)

References 20 publications

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“…Psychosis may be the first manifestation of endocrine abnormalities such as Cushing’s syndrome [ 1 ], hyperthyroidism [ 2 ], hypothyroidism [ 3 ] and rarely PHPT [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism presenting as acute psychosis secondary to hypercalcaemia requiring curative parathyroidectomy

Singh

Bauernfreund

Arya

et al. 2018

Journal of Surgical Case Reports

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Primary hyperparathyroidism (PHPT) can cause hypercalcaemia secondary to a pathologically high secretion of parathyroid hormone. Rarely this can first manifest as acute psychosis. It is imperative to exclude organic causes of psychosis before labelling the psychosis as primarily psychological. If hypercalcaemia is revealed, investigation is required to elucidate the underlying cause whilst instigating treatment to lower serum calcium levels. If PHPT is the underlying pathology, subsequent treatment involves surgical exploration and resection of the parathyroid adenoma or hyperplasia.

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“…Psychosis may be the first manifestation of endocrine abnormalities such as Cushing’s syndrome [ 1 ], hyperthyroidism [ 2 ], hypothyroidism [ 3 ] and rarely PHPT [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Primary hyperparathyroidism presenting as acute psychosis secondary to hypercalcaemia requiring curative parathyroidectomy

Singh

Bauernfreund

Arya

et al. 2018

Journal of Surgical Case Reports

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“…The presentation of hypercalcemia in children may range from an incidental asymptomatic biochemical finding to symptoms of hypotonia, poor feeding, vomiting, constipation, abdominal pain, lethargy, failure to thrive, polyuria, dehydration, and seizures . In severe cases, renal failure, pancreatitis, and reduced consciousness may also occur, and older children and adolescents may present with psychiatric symptoms . Clinical history and examination may provide diagnostic clues and guide further investigations.…”

Section: Definition and Presentation Of Hypercalcemiamentioning

confidence: 99%

“…(4,5) In severe cases, renal failure, pancreatitis, and reduced consciousness may also occur, and older children and adolescents may present with psychiatric symptoms. (6) Clinical history and examination may provide diagnostic clues and guide further investigations. The presence or absence of symptoms of hypercalcemia may indicate a particular diagnosis, and the urgency with which investigations should be pursued.…”

Section: Definition and Presentation Of Hypercalcemiamentioning

confidence: 99%

Hypercalcemic Disorders in Children

Stokes

Nielsen

Hannan

et al. 2017

Journal of Bone and Mineral Research

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Hypercalcemia is defined as a serum calcium concentration that is greater than two standard deviations above the normal mean, which in children may vary with age and sex, reflecting changes in the normal physiology at each developmental stage. Hypercalcemic disorders in children may present with hypotonia, poor feeding, vomiting, constipation, abdominal pain, lethargy, polyuria, dehydration, failure to thrive, and seizures. In severe cases renal failure, pancreatitis and reduced consciousness may also occur and older children and adolescents may present with psychiatric symptoms. The causes of hypercalcemia in children can be classified as parathyroid hormone (PTH)‐dependent or PTH‐independent, and may be congenital or acquired. PTH‐independent hypercalcemia, ie, hypercalcemia associated with a suppressed PTH, is commoner in children than PTH‐dependent hypercalcemia. Acquired causes of PTH‐independent hypercalcemia in children include hypervitaminosis; granulomatous disorders, and endocrinopathies. Congenital syndromes associated with PTH‐independent hypercalcemia include idiopathic infantile hypercalcemia (IIH), William's syndrome, and inborn errors of metabolism. PTH‐dependent hypercalcemia is usually caused by parathyroid tumors, which may give rise to primary hyperparathyroidism (PHPT) or tertiary hyperparathyroidism, which usually arises in association with chronic renal failure and in the treatment of hypophosphatemic rickets. Acquired causes of PTH‐dependent hypercalcemia in neonates include maternal hypocalcemia and extracorporeal membrane oxygenation. PHPT usually occurs as an isolated nonsyndromic and nonhereditary endocrinopathy, but may also occur as a hereditary hypercalcemic disorder such as familial hypocalciuric hypercalcemia, neonatal severe primary hyperparathyroidism, and familial isolated primary hyperparathyroidism, and less commonly, as part of inherited complex syndromic disorders such as multiple endocrine neoplasia (MEN). Advances in identifying the genetic causes have resulted in increased understanding of the underlying biological pathways and improvements in diagnosis. The management of symptomatic hypercalcemia includes interventions such as fluids, antiresorptive medications, and parathyroid surgery. This article presents a clinical, biochemical, and genetic approach to investigating the causes of pediatric hypercalcemia. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

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“…However, patients can present acutely with psychosis as the only presenting complaint leading to dangerous behaviours. 5 One study alludes to psychosis as a result of hypercalcaemia precipitating to a person attempting mass murder. 6 Despite the small size of the studies, there is a strong association between the surgical removal of the parathyroid glands and subsequent improvement or even complete resolution of psychiatric symptoms.…”

Section: Discussionmentioning

confidence: 99%