Lithium
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Hyperparathyroidism: 3 case reports Three women developed hyperparathyroidism during lithium treatment [dosage and route not stated]. A 51-year-old patient with bipolar disorder, who had been receiving lithium for 10 years, presented with fatigue and listlessness. Tests showed elevated creatinine, calcium and parathormone (PTH) levels. A preoperative echographic examination, performed 4 years later, revealed a solitary parathyroid adenoma. The adenoma was excised and her calcium and PTH levels normalised. Pathological studies of the resected specimen confirmed a benign parathyroid adenoma. After 2 years, her calcium levels remained stable and she was asymptomatic. A 47-year-old patient had been diagnosed with bipolar disorder at age 31 years, and had been receiving lithium since. She presented because of excessive sleeping, loss of libido, fatigue and listlessness. The latter symptom resolved after an antidepressant was prescribed, but the excessive sleeping persisted. Tests revealed elevated PTH and calcium levels; it was later noted that she had had hypercalcaemia for 2 years. Technetium scintigraphy suggested a thyroid adenoma, but a CT scan could not confirm this finding. After a calcimimetic was started, her calcium levels dropped and her symptoms improved. A 56-year-old patient, who had been receiving lithium for 10 years for a schizoaffective disorder, was referred because of renal function disorders. This was presumed to be due to chronic lithium treatment. She had polyuria of 6-8 L/day. Creatinine, calcium and PTH hormone levels were increased. She was diagnosed with nephrogenic diabetes insipidus and probable hyperparathyroidism secondary to chronic lithium use. A single parathyroid adenoma, which was found upon technetium scintigraphy, was surgically removed. Subsequently, her calcium levels normalised. A year later, her hypercalcaemia recurred; CT scan showed a parathyroid adenoma on the contralateral side. The lesion was excised and her calcium levels normalised. Her renal function disorders remained stable. Houweling BM, et al. Lithium-induced hyperparathyroidism. Nederlands Tijdschrift voor Geneeskunde 156: A4091, No. 7, 18 Feb 2012 [Dutch; summarised from a translation] - Netherlands
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Reactions 23 Jun 2012 No. 1407
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