Reversible Hypercalcemia and Hyperparathyroidism Associated With Lithium Therapy: Case Report and Review of Literature

Khandwala, Hasnain; Uum, Stan Van

doi:10.4158/ep.12.1.54

Cited by 43 publications

(56 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

“…Although serum Ca 2+ and PTH levels tend to normalize within 4 -6 weeks after lithium discontinuation, this change is mostly seen in patients receiving lithium for a relatively short-term defined as 5 -10 years, or in those with only mild hypercalcemia [4]. Khandawala et al reported on one patient who was taking lithium for 5 years, discontinuation of Li + resulted in normocalcemia and a normal PTH level which was maintained at 5 months follow-up [24]. Dugal et al reported on a single patient who had been on lithium therapy for 10 years, in whom discontinuation of lithium and simultaneous saline diuresis with furosemide also achi- Table 3…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Ballehaninna¹,

Nguyen²,

Chamberlain³

2011

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Ballehaninna¹,

Nguyen²,

Chamberlain³

2011

View full text Add to dashboard Cite

show abstract

“…However, one cannot definitely rule out a fortuitous association when a single PTA is found years after lithium discontinuation. In patients with LAH, who discontinue lithium therapy, there are some reports of fast resolution of the disease (29,30) when the duration of treatment was relatively short, up to 5 years; but hypercalcemia may not improve for as long as 8.5 weeks (7), especially after a long duration of lithium therapy (over 5 years of treatment), and will require surgery (18,19,29,31,32). In these cases, one could also propose the use of cinacalcet instead of surgery as a first-line therapy.…”

Section: The Use Of Cinacalcet Hydrochloride In Lahmentioning

confidence: 99%

Lithium-associated hyperparathyroidism: report of four cases and review of the literature

Szalat¹,

Mazeh²,

Freund³

2009

European Journal of Endocrinology

110

View full text Add to dashboard Cite

Context: Lithium-associated hyperparathyroidism (LAH) was first described in 1973 but many issues remain in question regarding the pathophysiology as well as the appropriate management of this condition. Objective: Report of four new cases and review of the literature. Results: We describe two males and two females, treated for more than 10 years with lithium due to bipolar disorder, who developed LAH. All underwent parathyroidectomy. In three cases (75%), pathology revealed multiglandular disease, with hyperplasia or two parathyroid adenomas. We observed a cure status in three (75%) of the operated patients. The fourth patient had a residual disease, but had controlled hypercalcemia under the calcimimetic drug cinacalcet. We also observed the association of LAH with incidental papillary thyroid carcinoma in two patients. Review of the literature identified a higher prevalence of LAH in women than men (four out of one) and a controversy in regard to the prevalence of multiglandular disease. As a result, there is no consensus regarding the preferred surgical procedure. The use of cinacalcet as an effective treatment of LAH was previously described in only five cases. Conclusion: In our view, there are apparently two different mechanisms leading to LAH: exacerbation of a pre-existing state of hyperparathyroidism and multiglandular disease. For uncontrolled hypercalcemia, parathyroidectomy is recommended. The issue of routine four-gland exploration and subtotal parathyroidectomy versus intraoperative PTH-determination-guided excision of enlarged glands is still unresolved. The use of the recently developed calcimimetics may offer an alternative to patients who are not candidates for surgery.

show abstract

“…• If there is heavy proteinuria (ACR ≥70 mg/mmol, roughly equivalent to PCR ≥100 mg/mmol, or urinary protein excretion ≥1 g/24 h), unless known to be due to diabetes and already appropriately treated with either increased or normal parathyroid levels develops in between 15 and 60% of patients on lithium (Khandwala 2006). The prevalence of hypercalcaemia is higher in patients with renal failure (owing to hypocalciuria), and nephrolithiasis and nephrocalcinosis are known complications (Grunfeld 2009).…”

Section: Hypercalcaemia and Hyperparathyroidismmentioning

confidence: 99%

Management of the renal adverse effects of lithium

Gupta¹,

Kripalani²,

Khastgir³

et al. 2013

Adv. psychiatr. treat

View full text Add to dashboard Cite

SummaryLithium is one of the most effective psychotropic drugs we have, but it is underused because of its low therapeutic index, the need for regular blood tests and perceptions about its adverse effects, including renal problems. The last include urinary concentration deficits and diabetes insipidus, chronic kidney disease (including renal failure), nephrotic syndrome, hypercalcaemia, hyperparathyroidism and distal tubular acidosis. This article reviews these adverse effects with special emphasis on their management.

show abstract

Reversible Hypercalcemia and Hyperparathyroidism Associated With Lithium Therapy: Case Report and Review of Literature

Cited by 43 publications

References 28 publications

Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach

Lithium-associated hyperparathyroidism: report of four cases and review of the literature

Management of the renal adverse effects of lithium

Contact Info

Product

Resources

About