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

Meehan, Adrian David; Humble, Mats B.; Yazarloo, Payam; Järhult, Johannes; Wallin, Göran

doi:10.1097/jcp.0000000000000303

Cited by 19 publications

(18 citation statements)

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“…LAH is characterised by mildly elevated calcium levels (Fig. 2 ), which occur chronically or intermittently [ 13 , 14 ]. Despite numerous articles highlighting the credible association between lithium and the development of hypercalcemia, the monitoring of parathyroid function has only recently been included in the revised recommendations of NICE [ 15 ] and the International Society for Bipolar Disorder [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hypercalcemia in lithium-treated patients with BPD was not correlated with kidney function, and even moderate chronic kidney insufficiency proved to be statistically insignificant (Table 3 ). The significance of hypercalcemia for the lithium-treated individual is unclear [ 14 ]. The GAF instrument did indicate that individuals with lithium treatment scored lower on this assessment of psychosocial functioning (Tables 1 , 2 ).…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lithium‐Associated Hypercalcemia: Pathophysiology, Prevalence, Management

et al. 2017

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“…Since its first description by Garfinkel et al in 1973 another possible cause for pHPT has been revealed: HPT associated with lithium medication [11]. Since then, about 300 cases of lithium-associated HPT (LIHPT) were described in cohort studies and case presentations [12].…”

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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“…However, despite beneficial action, the therapy may carry side-effects, affecting both life conditions and compliance of patients in a considerable way. Lithium's side-effects include hypercalcaemia, gastrointestinal, dermatological, cardiovascular, renal, as well as thyroid and parathyroid disorders [2,7,8,9,10,11,12]. Research has revealed its harmful influence on the functions of key organs, including liver and kidney [2,10,13,14] with the latter being particularly vulnerable [3,15,16].…”

Section: Introductionmentioning

confidence: 99%