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



(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.


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