Hyperparathyroidism lithium treatment

In the last case the authors concluded that the hypercalcemia was due to long-term lithium treatment and cited studies showing that hyperparathyroidism occurs in 5—40% of patients taking long-term lithium, compared with a population frequency of less than 4%. The patient s chief complaint included nausea when he was exposed to food and water, and he therefore refused food and water for 2-3 days before admission. He also had acute renal insufficiency, which was thought to be due to... 

Dieserud F, Brun AC, Lahne PE, Normann E. Litiumbehandling og hyperparatyreoidisme. [Lithium treatment and hyperparathyroidism.] Tidsskr Nor Laegeforen 2001 121(22) 2602-3. 

A causal relationship between lithium treatment and hyperparathyroidism has been suggested [37]. Lithium seems to induce morphological changes in the parathyroid glands with an increase in parathyroid volume, and an increase in cellular DNA synthesis [37-39], which may explain why its effects may not be completely reversible. It is not rare to find patients with hypercalcemia, usually mild, after discontinuation of prolonged lithium therapy. A number of cases have been reported where hypercalcemia and hypocalciuria persisted even after discontinuation. We also have seen persistence of hypercalcemia and hyperparathyroidism several years after discontinuation of lithium therapy [Batlle et al unpublished, 2000]. 

Stancer HC, Forbath N. Hyperparathyroidism, hypothyroidism, and impaired renal function after 10 to 20 years of lithium treatment. Arch Intern Med 1989 149 1042-1045. 

Hyperparathyroidism was considered a possible cause of treatment-resistant manic psychosis in a patient taking lithium (663). 

Abdullah H, Bliss R, Guinea Al, Delbridge L. Pathology and outcome of surgical treatment for lithium-associated hyperparathyroidism. Br J Surg 1999 86(l) 91-3. 

In six cases of hthium-associated hyperparathyroidism, four had parathyroid adenomas [67, 68 ]. The authors suggested that lithium can help uncover pre-existing parathyroid disease, although there does appear to be an increased incidence of multiglandular or multiadenomatous disease in patients taking lithium. Surgical treatment is often curative when adenomas are discovered. When hypercalcemia persists, cinacalcet, a calcimimetic can be used effectively. 

---