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The prevalence of lithium-associated hyperparathyroidism in a large Swedish population attending psychiatric outpatient units
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Geriatrics, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-5162-0328
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Psychiatry, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0001-6726-7787
Department of Psychiatry, Ryhov Hospital, Jönköping, Sweden .
Department of Surgery, Ryhov Hospital, Jönköping, Sweden .
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2015 (English)In: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 35, no 3, p. 279-285Article in journal (Refereed) Published
Abstract [en]

Objective: This retrospective study determined the prevalence of lithium-associated hyperparathyroidism (LHPT) in 2 geographically defined, equivalent populations in Sweden, with no other selection bias.

Methods: The medical journals of all patients receiving lithium treatment were examined specifically regarding their biochemistry: calcium, parathyroid hormone (PTH), creatinine, and vitamin D. The condition LHPT was defined biochemically. All patient data were noted, and the prevalence of the condition could thereby be calculated.

Results: A total of 423 patients were included (251 women and 172 men; 3: 2), treated over a mean of 13.5 years (range, 1-46 years), aged 19 to 92. 77 patients (18%) were identified with LHTP whose median serum calcium-was 2.55 mmol/L and PTH was 99 ng/L. A further 21% showed tendencies toward hypercalcemia. Forty-three percent had vitamin D insufficiency. Five patients (approximately 1%) had undergone parathyroidectomy.

Conclusion: The prevalence of LHPT is high and often goes undetected. Vitamin D insufficiency is common as is polypharmacy. Surgery, for unclear reasons, has not been performed extensively, possibly because of limited knowledge of the underlying pathophysiology or surgery's significance. We present standard recommendations on patient management and suggest continual, specific follow-up including the monitoring of calcium, PTH, and vitamin D at least annually. Surgery should be considered with intention to improve psychiatric well-being and provide multiorgan protection.

Place, publisher, year, edition, pages
2015. Vol. 35, no 3, p. 279-285
Keywords [en]
hypercalcemia; hyperparathyroidism; Lithium; prevalence
National Category
Pharmacology and Toxicology Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-44863DOI: 10.1097/JCP.0000000000000303ISI: 000353817400011PubMedID: 25853371Scopus ID: 2-s2.0-84929161233OAI: oai:DiVA.org:oru-44863DiVA, id: diva2:818844
Available from: 2015-06-09 Created: 2015-06-09 Last updated: 2018-06-30Bibliographically approved
In thesis
1. Lithium-associated hyperparathyroidism: Prevalence, Pathophysiology, Management
Open this publication in new window or tab >>Lithium-associated hyperparathyroidism: Prevalence, Pathophysiology, Management
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Lithium has been used in the treatment of bipolar disorder, formerly called manic depression, for nearly seven decades. Lithium-associated hyperparathyroidism (LHPT) is an ill-defined and less well known possible side-effect of chronic lithium therapy and was first described in 1973. The condition has been considered to be rare, though there exists conflicting evidence as to its prevalence, its pathophysiological background, and, if and when identified, what the appropriate medical or surgical treatment should be. The principal aim of this thesis was to understand and more comprehensively characterise this condition through studying a large patient cohort, with regards its prevalence, development, and additionally by providing an evaluation of surgical management up until now.

In Study I a population of 423 lithium-treated out-patients (251 women, 172 men) were recruited from Jönköping and Örebro County. We found that 18% met the criteria for hyperparathyroidism (HPT) and that a further 21% had intermittent episodes of hypercalcaemia. We then examined, in Study II, the effects of lithium only in patients with bipolar disorder and compared them, firstly, to patients with bipolar disorder without lithium and, secondly, to a control population. In total, 563 individuals participated in the study. Hypercalcaemia was found to be strongly associated to lithium therapy (adjusted OR 13.45; 95% CI 3.09, 58.55; p=0.001). Study III is a descriptive study of calcium homeostasis in 297 lithium-treated patients from Jönköping where three main groups could be discerned: 178 were normocalcaemic (60%), 102 hypercalcaemic (34%), and 17 hypocalcaemic (6%). Many patients demonstrate robust fluctuations in serum calcium intermittently. Of those with suspected LHPT, 31% had urinary calcium excretion values be-low 1.2 mmol/24hrs. Study IV analysed surgical results of 78 parathyroidectomies in 71 patients with concurrent lithium therapy. In strong contrast to surgical outcomes in those with primary HPT, the overall cure-rate was lower (58%) and the predominant histological diagnosis was hyperplasia (52%). Two patients had double adenomas.

Factors which should be particularly taken into consideration while monitoring lithium-treated patients are age, gender and lithium-duration.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 70
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 174
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-65002 (URN)978-91-7529-234-2 (ISBN)
Public defence
2018-04-06, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-03-15Bibliographically approved

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Meehan, Adrian D.Humble, Mats B.

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