Lithium and Symptomatic Hyperparathyroidism

Ananth, Jambur; Dubin, Stephen

doi:10.1177/014107688307601210

Cited by 33 publications

(21 citation statements)

References 15 publications

(19 reference statements)

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“…Of these, 71 patients had surgically verified hyperparathyroidism of whom 42 patients were found to have adenomas (Garfinkel et al, 1973;Christensson, 1976;MacGregor, 1977;Toffaletti et al, 1979;Graze, 1981;Ananth and Dubin, 1983;McHenry et al, 1990;Nordenstrom et al, 1992;Abdullah et al, 1999;Awad et al, 2003;Dalan et al, 2007;Rizwan and Perrier, 2009;Szalat et al, 2009). In addition, 29 patients were found to have diffuse parathyroid hyperplasia (Cairns et al, 1985;Krivitzky et al, 1986;McHenry et al, 1990;Feldman and Pachman, 1990;Tissel et al, 1991;Nordenstrom et al, 1992;Abdullah et al, 1999;Awad et al, 2003;Hundley et al, 2005;Rizwan and Perrier, 2009;Szalat et al, 2009).…”

Section: Resultsmentioning

confidence: 99%

“…In addition, 29 patients were found to have diffuse parathyroid hyperplasia (Cairns et al, 1985;Krivitzky et al, 1986;McHenry et al, 1990;Feldman and Pachman, 1990;Tissel et al, 1991;Nordenstrom et al, 1992;Abdullah et al, 1999;Awad et al, 2003;Hundley et al, 2005;Rizwan and Perrier, 2009;Szalat et al, 2009). In the remaining case reports, hyperparathyroid states were not surgically verified (Cervi-Skinner, 1977;Toffaletti et al, 1979;Herman, 1981;Davis et al, 1981;Rothman, 1982;Shen and Sherrard, 1982;Ananth and Dubin, 1983;Prasad, 1984;Mallette and Eichhorn, 1986;Rifai et al, 2001;Bilanakis and Gibiriti, 2004;Sloand and Shelly, 2006). Table 1 summarizes findings of 12 cross-sectional studies of hyperparathyroidism in lithium-treated patients compared with control cohorts.…”

Section: Resultsmentioning

confidence: 99%

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Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: What do we know?

Lehmann

Lee

2013

Journal of Affective Disorders

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: What do we know?

Lehmann

Lee

2013

Journal of Affective Disorders

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“…However, one cannot definitely rule out a fortuitous association when a single PTA is found years after lithium discontinuation. In patients with LAH, who discontinue lithium therapy, there are some reports of fast resolution of the disease (29,30) when the duration of treatment was relatively short, up to 5 years; but hypercalcemia may not improve for as long as 8.5 weeks (7), especially after a long duration of lithium therapy (over 5 years of treatment), and will require surgery (18,19,29,31,32). In these cases, one could also propose the use of cinacalcet instead of surgery as a first-line therapy.…”

Section: The Use Of Cinacalcet Hydrochloride In Lahmentioning

confidence: 99%

Lithium-associated hyperparathyroidism: report of four cases and review of the literature

Szalat¹,

Mazeh²,

Freund³

2009

European Journal of Endocrinology

109

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Context: Lithium-associated hyperparathyroidism (LAH) was first described in 1973 but many issues remain in question regarding the pathophysiology as well as the appropriate management of this condition. Objective: Report of four new cases and review of the literature. Results: We describe two males and two females, treated for more than 10 years with lithium due to bipolar disorder, who developed LAH. All underwent parathyroidectomy. In three cases (75%), pathology revealed multiglandular disease, with hyperplasia or two parathyroid adenomas. We observed a cure status in three (75%) of the operated patients. The fourth patient had a residual disease, but had controlled hypercalcemia under the calcimimetic drug cinacalcet. We also observed the association of LAH with incidental papillary thyroid carcinoma in two patients. Review of the literature identified a higher prevalence of LAH in women than men (four out of one) and a controversy in regard to the prevalence of multiglandular disease. As a result, there is no consensus regarding the preferred surgical procedure. The use of cinacalcet as an effective treatment of LAH was previously described in only five cases. Conclusion: In our view, there are apparently two different mechanisms leading to LAH: exacerbation of a pre-existing state of hyperparathyroidism and multiglandular disease. For uncontrolled hypercalcemia, parathyroidectomy is recommended. The issue of routine four-gland exploration and subtotal parathyroidectomy versus intraoperative PTH-determination-guided excision of enlarged glands is still unresolved. The use of the recently developed calcimimetics may offer an alternative to patients who are not candidates for surgery.

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“…In addition, lithium therapy has been associated with the development of hypercalcemia and/or elevated levels of PTH, as well as overt primary hyperparathyroidism, in pa¬ tients on chronic therapy (3)(4)(5)(6)(7)(8)(9). Therefore, it is possible that lithium leads to hyperparathyroidism in humans by altering calcium-regulated PTH re¬ lease.…”

mentioning

confidence: 99%

A single dose of lithium carbonate acutely elevates intact parathyroid hormone levels in humans

Seely

Moore

LeBoff

et al. 1989

Acta Endocrinologica

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Hyperparathyroidism has been reported in patients receiving lithium therapy, and lithium alters calcium-regulated PTH release in vitro. Previous studies in vivo have used assays which measure fragments of PTH as well as the intact hormone. To determine if lithium acutely elevates intact PTH levels, we studied 9 subjects who received a single oral dose of lithium carbonate (600 mg). Serum levels of intact PTH, ionized calcium, and lithium were measured before, 2 and 14 h after the dose of lithium. PTH levels rose significantly 2 h following the dose of lithium (before 22 \ m=+-\ 5.0, post 32 \ m=+-\7.3 ng/l, p < 0.02). PTH levels had returned to baseline at 14 h (22 \ m=+-\ 3.8 ng/l). There were no significant changes in ionized calcium levels. Therefore, a single oral dose of lithium carbonate acutely elevates intact PTH values in human subjects.In vitro, lithium increases the set-point for para¬ thyroid hormone release in response to calcium (1) and stimulates release of intact PTH from human parathyroid cells (2). In addition, lithium therapy has been associated with the development of hypercalcemia and/or elevated levels of PTH, as well as overt primary hyperparathyroidism, in pa¬ tients on chronic therapy (3-9). Therefore, it is possible that lithium leads to hyperparathyroidism in humans by altering calcium-regulated PTH re¬ lease.Previous in vivo studies have employed various radioimmunoassays for PTH which measure frag¬ ments as well intact hormone. Since lithium has significant renal effects, it is possible that alter¬ ations in PTH levels may have resulted from changes in clearance of such hormonal fragments (10). This study was designed to investigate the acute effect of a single oral dose of lithium carbo¬ nate on PTH levels in human subjects using a radioimmunometric assay specific for intact PTH. Subjects and Methods MethodsNine healthy volunteers on no medications received a single oral dose of 600 mg of lithium carbonate. Four subjects were normotensive and 5 had a history of mild hypertension without medical complications (3 had never been on medication and 2 had been off medication for greater than one month). Blood was drawn prior to, 2 h and 14 h following the dose of lithium and analyzed for intact PTH, ionized calcium and lithium. The blood sample for ionized calcium was drawn without a tourni¬ quet and handled anaerobically. Serum creatinine was measured and urine was collected for determination of creatinine clearance 12 h preceding and 12 h following the lithium dose.Intact PTH (normal 10-65 ng/1) was measured using the Allegro1" intact PTH assay (Nichols Institute, San Juan Capistrano, CA). In our laboratory, the detection limit (the amount of PTH giving an increase in bound counts > 2 standard deviations above blank of the assay) was in all cases 4 ng/1 or less. This was at least 2-fold lower than the lowest value for PTH measured in the study. In addition, our intra-assay coefficient of variation (all sam¬ ples were measured in duplicate) was 3.4%, which was 2-to 3-fold less than the sm...

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Lithium and Symptomatic Hyperparathyroidism

Cited by 33 publications

References 15 publications

Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: What do we know?

Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: What do we know?

Lithium-associated hyperparathyroidism: report of four cases and review of the literature

A single dose of lithium carbonate acutely elevates intact parathyroid hormone levels in humans

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