Lithium-induced hypercalcemia and hyperparathyroidism presenting with delirium

Duggal, Harpreet S.; Singh, Ira

doi:10.1016/j.pnpbp.2007.12.014

Cited by 9 publications

(8 citation statements)

References 7 publications

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“…Likewise, Jarhult et al studied 71 patients with LAH and reported MGH in 37 patients (52%) [14]. Table 1 summarizes all reported LAH cases and demonstrates that parathyroid adenoma was the most common pathology identified in 104 out of 170 patients (61%) following parathyroidectomy [3,5,8,[23][24][25][26]. (Table 1) In comparison, PHPT is associated with a single adenoma 85%, multigland hyperplasia (MGH) 15% and parathyroid carcinoma in 1% of patients [7].…”

Section: Discussionmentioning

confidence: 99%

“…(Table 2) Data relating to the efficacy of LAH medical management is available for only 10 of 194 reported LAH patients (5%). As such it is difficult to make any meaningful conclusions [12,[23][24][25][26]34]. In many LAH patients, discontinuation of lithium carbonate is not medically feasible due to increased propensity of relapse [35,36].…”

Section: Discussionmentioning

confidence: 99%

“…eved normocalcemia [26]. In contrast, drug withdrawal from patients on chronic lithium therapy (>10 years), has a lower rate of hypercalcemia resolution [4].…”

Section: ) LImentioning

confidence: 99%

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Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Ballehaninna¹,

Nguyen²,

Chamberlain³

2011

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Background: Long-term lithium use in psychiatric patients may lead to lithium associated hyperparathyroidism (LAH). Although anecdotal case reports have appeared, an evidence based algorithm for management of LAH is lacking. Methods: A comprehensive literature search was performed using PubMed with keywords; "lithium" "hypercalcemia" "hyperparathyroidism" "sestamibi" "intra-operative parathyroid hormone (IOPTH) monitoring" "parathyroidectomy" and "medical management". All English language publications addressing etiology and clinical management issues concerning LAH were critically analyzed. Results: Lithium associated hyperparathyroidism occurs in 4.3% -6.3% of chronic lithium users compared to the general population which has an incidence of 0.5% -1%. 194 cases of LAH have been reported which includes 10 patients (5%) treated medically and 170 patients (88%) who underwent parathyroidectomy. No details were available for 14 patients (7%). Among parathyroidectomy patients, 104 (59%) had adenomatous disease and 66 (39%) had multiglandular hyperplasia. Preoperative localization studies were utilized in only 22 patients (13%) and IOPTH monitoring was reported in only 3 studies (32 patients, 19%). Among surgical patients, bilateral neck exploration (BNE) was the most common approach performed in 162 patients (95%); focused neck exploration was utilized in only 8 patients (5%). Parathyroidectomy normalized LAH biochemical changes in nearly all patients (90% -97%) in the early post-operative period, but recurrent hyperparathyroidism occurred in 8% -42% of patients. Conclusion: LAH is an under appreciated and poorly understood endocrine disorder. LAH has a higher incidence of multiglandular disease and bilateral neck exploration is mandatory in majority for disease control. Nonsurgical approaches may be useful in select patients on short-term lithium therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Ballehaninna¹,

Nguyen²,

Chamberlain³

2011

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“…10 One article published in an endocrine journal describes a similar case in which a patient on longterm lithium therapy was admitted with sepsis and developed hypercalcaemia 10 days later, which resolved on withdrawal of the lithium. 11 During her admission, our patient was diagnosed with nephrogenic diabetes insipidus (NDI) by the endocrine team.…”

Section: Discussionmentioning

confidence: 99%

Delirium associated with therapeutic levels of lithium in bipolar disorder

Clough¹,

Henry²,

Ekelund³

2014

Prog Neurol Psychiatry

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“…In mild cases, patients may present with anxiety, depression, and cognitive changes, while altered mental status, psychosis, confusion, lethargy, and coma hallmark severe hypercalcemia [1]. Several cases of hypercalcemiarelated delirium have been reported in the literature, often secondary to hyperparathyroidism, parathyroid adenoma, lithium toxicity, and cancer [2][3][4][5]. These cases describe patients presenting with sudden alteration in mental status accompanied by auditory hallucinations, paranoia, and persecutory delusions [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Prolonged Hypercalcemia-Induced Psychosis

Nagy

Mangini

Schroen

et al. 2020

Case Reports in Psychiatry

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Hypercalcemia is known to cause neuropsychiatric dysfunction including mood and cognitive changes and rarely, acute psychosis. High calcium levels can be a catalyst for neuronal demise, possibly due to glutaminergic excitotoxicity and dopaminergic and serotonergic dysfunction. While restoration of normal calcium levels or removal of a parathyroid adenoma has been shown to rapidly resolve neuropsychiatric symptoms, there have been rare reported cases of primary hyperparathyroid-related hypercalcemia with persistent symptoms of psychosis. In this case report, we will describe a patient with no past psychiatric history presenting with a protracted course of delirium and psychosis after a removal of a parathyroid adenoma which had caused prolonged exposure to hypercalcemia. The patient’s psychosis was unresponsive to psychotropic medication and required inpatient psychiatric care after medical clearance. Per medical records, before the patient was ultimately lost to follow-up, she continued to suffer from psychotic symptoms for at least 8 months. We will discuss the patient’s unusual hospital course and management and offer suggestions for future study.

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Lithium-induced hypercalcemia and hyperparathyroidism presenting with delirium

Cited by 9 publications

References 7 publications

Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Delirium associated with therapeutic levels of lithium in bipolar disorder

Prolonged Hypercalcemia-Induced Psychosis

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