Long-term results of surgery for lithium-associated hyperparathyroidism

Järhult, Johannes; Ander, Stefan; Asking, B.; Jansson, Svante; Meehan, Adrian David; Kristoffersson, Anders; Nordenström, Jörgen

doi:10.1002/bjs.7199

Cited by 35 publications

(70 citation statements)

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“…McHenry et al have reported that 80% of patients treated with lithium for 6 to 24 months experience a 10% increase in serum calcium levels. Christiansen et al re-ported that both serum calcium and PTH levels increased by 30% in the same population, and several other authors have also reported a 10% -60% increased prevalence of hypercalcemia and hyperparathyroidism in patients taking lithium [11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…Nordenstrom et al identified multiglandular hyperplasia (MGH) in 83% of LAH patients (5 out of 6) [19]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…Among 170 patients with LAH, BNE was used in 162 patients (95%), whereas focused neck exploration was performed in only 8 patients (5%). In the largest reported LAH series, Jarhult et al utilized BNE in all but 2 of 71 patients who underwent parathyroidectomy [14].…”

Section: ) LImentioning

confidence: 99%

“…In a study of 16 patients, Carchman et al performed focused parathyroidectomy in 8 patients, while 8 patients underwent BNE guided by IOPTH monitoring [19]. Of note, these authors were able to perform a limited surgical exploration in 50% of LAH patients, compared to a 5% rate in other LAH series [12,14].…”

Section: ) LImentioning

confidence: 99%

“…At a median follow-up of 6 months (5 -50 months range), Carchman et al noted that all patients were eucalcemic, however 2 patients had mild PTH elevation [19]. In contrast, Jarhult et al reported that among 71 LAH patients who underwent parathyroidectomy, 30 patients (42%) had persistent or recurrent hyperparathyroidism at a median follow-up of 6.3 years [14]. In this series, six out of 30 patients with persistent/recurrent HPT underwent surgical re-exploration but only 2 patients were cured of hypercalcemia, one had permanent hypocalcaemia.…”

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%