Long-term outcome after parathyroidectomy for lithium-induced hyperparathyroidism

Norlén, Olov; Sidhu, Stan; Sywak, Mark; Delbridge, Leigh

doi:10.1002/bjs.9589

Cited by 23 publications

(18 citation statements)

References 19 publications

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“…The definitions used and the length of exposure to lithium can at least partly, explain the discrepancies. Though the majority of these patients (approximately 50 %) have a single parathyroid adenoma, there is a higher incidence of multiple adenomas compared with the ordinary pHPT patient cohort [ 33 – 36 ]. Many hypotheses on the underlying mechanism of LAH have been proposed including: increased threshold of the calcium-sensing receptor, increased secretion of the PTH, decrease of calcium uptake, inhibition of action of glycogen synthase kinase 3b and reduction of PTH gene transcription [ 37 ].…”

Section: Pathogenesis Of Sporadic Multiglandular Diseasementioning

confidence: 99%

Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES)

Barczyński

Bränström

Dionigi

et al. 2015

Langenbecks Arch Surg

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BackgroundSporadic multiglandular disease (MGD) has been reported in literature in 8–33 % of patients with primary hyperparathyroidism (pHPT). This paper aimed to review controversies in the pathogenesis and management of sporadic MGD.MethodsA literature search and review was made to evaluate the level of evidence concerning diagnosis and management of sporadic MGD according to criteria proposed by Sackett, with recommendation grading by Heinrich et al. and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled ‘Hyperparathyroidism due to multiple gland disease: An evidence-based perspective’.ResultsLiterature reports no prospective randomised studies; thus, a relatively low level of evidence was achieved. Appropriate surgical therapy of sporadic MGD should consist of a bilateral approach in most patients. Unilateral neck exploration guided by preoperative imaging should be reserved for selected patients, performed by an experienced endocrine surgeon and monitored by intraoperative parathormone assay (levels of evidence III–V, grade C recommendation). There is conflicting or equally weighted levels IV–V evidence supporting that cure rates can be similar or worse for sporadic MGD than for single adenomas (no recommendation). Best outcomes can be expected if surgery is performed by an experienced parathyroid surgeon working in a high-volume centre (grade C recommendation). Levels IV–V evidence supports that recurrent/persistence pHPT occurs more frequently in patients with double adenomas hence in situations where a double adenoma has been identified, the surgeon should have a high index of suspicion during surgery and postoperatively for the possibility of a four-gland disease (grade C recommendation).ConclusionsIdentifying preoperatively patients at risk for MGD remains challenging, intraoperative decisions are important for achieving acceptable cure rates and long-term follow-up is mandatory in such patients.

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Section: Pathogenesis Of Sporadic Multiglandular Diseasementioning

confidence: 99%

Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES)

Barczyński

Bränström

Dionigi

et al. 2015

Langenbecks Arch Surg

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“…Nevertheless, in the biggest study concerning LIHPT so far, published by Järhult et al in 2010 (n = 71), only 45 % of the patients with LIHPT had single adenomas and the cure rate was not more than 58 % [21]. Several other studies also showed high rates of MGD among patients with LIHPT [14,[20][21][22][23][24] while others found singu-lar adenomas in the majority of cases [25,26]. They go in line with the present study, in which out of five patients with LIHPT who underwent primary surgery only one had four gland hyperplasia (20 %) and no one had any recurrent or persistent disease.…”

Section: Discussionmentioning

confidence: 97%

“…While some studies reported high rates of MGD in LIHPT ranging from 52 and 75 % [14,[20][21][22][23][24], others reported single parathyroid adenomas in the majority of cases [25,26]. Furthermore, some claimed high rates of persistent/recurrent disease after surgery [21,24].…”

Section: Contextmentioning

confidence: 99%

Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

Dillenberger

Bartsch

Maurer

et al. 2019

Exp Clin Endocrinol Diabetes

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Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

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“…Carchman et al [ 9 ], however, state that there is no significantly increased risk for multiglandular disease (MGD) in lithium-treated patients. On the other hand, numerous studies present higher frequencies of MGD ranging from 25 to 83% [ 10 , 26 , 33 – 37 ]. The surgical results in the present study further confirm these latter results with MGD occurring in five of seven patients (70%) (Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

Lithium‐Associated Hypercalcemia: Pathophysiology, Prevalence, Management

et al. 2017

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BackgroundLithium-associated hypercalcemia (LAH) is an ill-defined endocrinopathy. The aim of the present study was to determine the prevalence of hypercalcemia in a cohort of bipolar patients (BP) with and without concomitant lithium treatment and to study surgical outcomes for lithium-associated hyperparathyroidism.MethodsRetrospective data, including laboratory results, surgical outcomes and medications, were collected from 313 BP treated with lithium from two psychiatric outpatient units in central Sweden. In addition, data were collected from 148 BP without lithium and a randomly selected control population of 102 individuals. Logistic regression was used to compare odds of hypercalcemia in these respective populations.ResultsThe prevalence of lithium-associated hypercalcemia was 26%. Mild hypercalcemia was detected in 87 out of 563 study participants. The odds of hypercalcemia were significantly higher in BP with lithium treatment compared with BP unexposed to lithium (adjusted OR 13.45; 95% CI 3.09, 58.55; p = 0.001). No significant difference was detected between BP without lithium and control population (adjusted OR 2.40; 95% CI 0.38, 15.41; p = 0.355). Seven BP with lithium underwent surgery where an average of two parathyroid glands was removed. Parathyroid hyperplasia was present in four patients (57%) at the initial operation. One patient had persistent disease after the initial operation, and six patients had recurrent disease at follow-up time which was on average 10 years.ConclusionThe high prevalence of LAH justifies the regular monitoring of calcium homeostasis, particularly in high-risk groups. If surgery is necessary, bilateral neck exploration should be considered in patients on chronic lithium treatment. Prospective studies are needed.

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Long-term outcome after parathyroidectomy for lithium-induced hyperparathyroidism

Abstract: Surgery provided a safe and effective management option for patients with LiHPT in this series, with a long-term cure rate of well over 80 per cent.

Cited by 23 publications

References 19 publications

Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES)

Sporadic multiple parathyroid gland disease—a consensus report of the European Society of Endocrine Surgeons (ESES)

Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

Lithium‐Associated Hypercalcemia: Pathophysiology, Prevalence, Management

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