Lithium-associated hyperparathyroidism and hypercalcaemia: A case-control cross-sectional study

Albert, Umberto; Cori, David De; Aguglia, Andrea; Barbaro, Francesca; Lanfranco, Fabio; Bogetto, Filippo; Maina, Giuseppe

doi:10.1016/j.jad.2013.06.046

Cited by 45 publications

(38 citation statements)

References 24 publications

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“…The rate of LAH has been reported to be as high as 23.2% [4], which is much higher than the 0.5% rate of sporadic HPT [5]. Despite its high incidence rate, LAH has not received appropriate attention as a serious side effect of lithium treatment [6]. …”

Section: Introductionmentioning

confidence: 99%

Lithium-Associated Hyperparathyroidism: A Pooled Analysis

Ibrahim

Mohamed²,

Deniwar³

et al. 2015

ORL

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Background: Lithium treatment has been associated with hyperparathyroidism (HPT). However, there are conflicting data regarding the rate of single- (SGD) versus multiple-gland disease (MGD) as well as the optimum surgical approach in these cases. Methods: Published data were identified through systematic electronic literature searches. Studies that fulfilled the preset inclusion criteria were analyzed (n = 12). Results: These studies documented 210 lithium-associated HPT (LAH) cases. Of these, 103 (49%) were due to SGD and 107 (51%) due to MGD. The unadjusted odds ratio of having multiple LAH compared to sporadic HPT was 3.44 (95% confidence interval 2.5907-4.5633; p < 0.0001). The sensitivity of preoperative sestamibi and sonography for SGD was 66-100 and 75-82%, respectively. The sensitivity for MGD was 9-67% for both. Intraoperative parathyroid hormone monitoring was utilized in 6 studies. Three studies recommended minimally invasive parathyroidectomy (MIP), while the other 3 recommended bilateral exploration. Conclusion: LAH is a relatively frequent condition among patients on lithium, and calcium monitoring should be performed initially and longitudinally. Almost half of the LAH cases are due to SGD. MIP should be the optimum surgical approach.

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Section: Introductionmentioning

confidence: 99%

Lithium-Associated Hyperparathyroidism: A Pooled Analysis

Ibrahim

Mohamed²,

Deniwar³

et al. 2015

ORL

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“…In a recent case-control study, PTH and ionized calcium levels were significantly higher in Li-exposed patients, and the proportions of subjects with hyperparathyroidism (8.6 %) and hypercalcaemia (24.1 %) were significantly greater in Liexposed patients [65]. Li may constitute a safe option in BD patients with high risk of hyperprolactinemia, considering that it lowers serum prolactin levels, especially during long-term treatment [66,67].…”

Section: Lithiummentioning

confidence: 91%

“…Parathyroid Given the underestimated prevalence of parathyroid alterations in Li-treated patients, calcium (and eventually PTH) should be added to routine lab tests [65].…”

Section: Endocrinologicalmentioning

confidence: 99%

Management of Adverse Effects of Mood Stabilizers

Murru

Popović

Pacchiarotti

et al. 2015

Curr Psychiatry Rep

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Mood stabilizers such as lithium and anticonvulsants are still standard-of-care for the acute and long-term treatment of bipolar disorder (BD). This systematic review aimed to assess the prevalence of their adverse effects (AEs) and to provide recommendations on their clinical management. We performed a systematic research for studies reporting the prevalence of AEs with lithium, valproate, lamotrigine, and carbamazepine/oxcarbazepine. Management recommendations were then developed. Mood stabilizers have different tolerability profiles and are eventually associated to cognitive, dermatological, endocrine, gastrointestinal, immunological, metabolic, nephrogenic, neurologic, sexual, and teratogenic AEs. Most of those can be transient or dose-related and can be managed by optimizing drug doses to the lowest effective dose. Some rare AEs can be serious and potentially lethal, and require abrupt discontinuation of medication. Integrated medical attention is warranted for complex somatic AEs. Functional remediation and psychoeducation may help to promote awareness on BD and better medication management.

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“…22 Accepted praxis involves usually only the monitoring of thyroid values, creatinine, and lithium concentrations regularly throughout the year. Multiple studies have indicated tendencies in lithiumtreated patients of hypercalcemia 15,[23][24][25] or hyperparathyroidism (HPT), 23,26,27 but recommendations concerning treatment are elusive and little is known about the implications for the individual patient with regard to quality of life or psychiatric well-being during episodes of disturbances in calcium homeostasis. Calcium status is most commonly measured using total calcium and/or albumin-adjusted calcium, although ionized "free" calcium provides greater specificity and sensitivity for calcium disturbances in HPT.…”

mentioning

confidence: 99%

“…7,9,[32][33][34] Hitherto, to our knowledge, few studies in English have calculated the level of prevalence of LHPT based on a larger population treated with lithium. 5,[23][24][25][26][27][28][29][30][31][32][33][34][35] In this study, we present a working definition for LHPT and have aimed to determine the prevalence of LHPT in 2 geographically defined, equivalent populations in central Sweden.…”

mentioning

confidence: 99%

The Prevalence of Lithium-Associated Hyperparathyroidism in a Large Swedish Population Attending Psychiatric Outpatient Units

Meehan¹,

Humble²,

Yazarloo³

et al. 2015

Journal of Clinical Psychopharmacology

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The prevalence of LHPT is high and often goes undetected. Vitamin D insufficiency is common as is polypharmacy. Surgery, for unclear reasons, has not been performed extensively, possibly because of limited knowledge of the underlying pathophysiology or surgery's significance. We present standard recommendations on patient management and suggest continual, specific follow-up including the monitoring of calcium, PTH, and vitamin D at least annually. Surgery should be considered with intention to improve psychiatric well-being and provide multiorgan protection.

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Lithium-associated hyperparathyroidism and hypercalcaemia: A case-control cross-sectional study

Cited by 45 publications

References 24 publications

Lithium-Associated Hyperparathyroidism: A Pooled Analysis

Lithium-Associated Hyperparathyroidism: A Pooled Analysis

Management of Adverse Effects of Mood Stabilizers

The Prevalence of Lithium-Associated Hyperparathyroidism in a Large Swedish Population Attending Psychiatric Outpatient Units

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