Lithium-associated hyperparathyroidism

Abstract

Lithium is a mood stabiliser widely used in the treatment and prophylaxis of mania, bipolar disorders and recurrent depression. Treatment with lithium can give rise to various endocrine and metabolic abnormalities, including thyroid dysfunction, nephrogenic diabetes insipidus and hypercalcaemia. Lithium may induce hypercalcaemia through both acute and chronic effects. The initial acute effects are potentially reversible and occur as a result of lithium's action on the calcium-sensing receptor pathway and glycogen synthase kinase 3, giving rise to a biochemical picture similar to that seen in familial hypocalciuric hypercalcaemia. In the long term, chronic lithium therapy leads to permanent changes within the parathyroid glands by either unmasking hyperparathyroidism in patients with a subclinical parathyroid adenoma or possibly by initiating multiglandular hyperparathyroidism. The latter biochemical picture is identical to that of primary hyperparathyroidism. Lithium-associated hyperparathyroidism, especially in patients on chronic lithium therapy, is associated with increased morbidity. Hence, regular monitoring of calcium levels in patients on lithium therapy is of paramount importance as early recognition of lithium-associated hyperparathyroidism can improve outcomes. This review focuses on the definition, pathophysiology, presentation, investigations and management of lithium-associated hyperparathyroidism.

Lithium-associated hypercalcemia: Monitoring and management

“…In most cases, LAH is an insidious adverse effect that is usually detected on blood tests after many years of lithium therapy. 8 For patients starting lithium therapy, International Society of Bipolar Disorder guidelines recommend testing calcium levels at baseline, 6 months, and annually thereafter, or as clinically indicated, to detect and monitor hypercalcemia and hyperparathyroidism. However, these guidelines do not provide any recommendations regarding how to manage abnormal findings.…”

“…If PTH is suppressed, then the raised calcium levels are probably secondary to something other than lithium; common reasons for this include the use of vitamin D supplements or thiazide diuretics, or malignancies such as multiple myeloma. 3,5,8…”

“…Hence, close monitoring of calcium and PTH is required even after discontinuing lithium. 3,8 Surgical treatment. The primary treatment of LAH and primary hyperparathyroidism is parathyroidectomy.…”

What affects chronic lithium poisoning in psychiatric patients? - a case report

“…Lithium is a drug that has been used for more than 60 years as a mood stabilizer in the treatment and prophylaxis of bipolar disorder, mania and recurrent depression. [1,2] It reduces the risk of suicide, shortterm mortality and violent behavior. [3,4] Higher concentrations of lithium in tap water have been shown to be associated with less rape, homicide and suicidal behavior in the community.…”

Lithium therapy and parathyroid gland interaction

“…ithium is a trace element that has been commonly used in treating bipolar affective disorder for years (1). Lithium therapy causes renal failure, several endocrine and metabolic abnormalities, such nephrogenic diabetes insipidus, thyroid abnormalities, and hypercalcemia (2)(3)(4). Despite the renal and endocrine disturbances, it has been demonstrated that a micro-dose of lithium may have anti-aging and anti-dementia effects in addition to its anti-suicidal efficacy (5).…”