Some patients receiving chronic lithium therapy may develop hyperparathyroidism. Hypercalcemia can cause symptoms that may be misinterpreted as worsening of bipolar disease.
Possible mechanisms:
(1) exacerbation of subclinical parathyroid adenoma
(2) multiglandular hyperplasia
Patient selection: chronic lithium therapy
Criteria:
(1) The patient develops: hypercalcemia, hypocalciuria, cardiac conduction defects with bradycardia, and elevated serum parathyroid hormone
(2) The onset follows the initiation of lithium therapy.
(3) The disorder may reverse on discontinuation of the lithium therapy. However, hypercalcemia may persist for some time and surgery may be necessary to remove a hyperactive parathyroid gland.
(4) No other explanation identified.
To read more or access our algorithms and calculators, please log in or register.
