Lithium-Associated Hyperparathyroidism Followed by Catatonia
| Autor: | Shankarapura N. Muralidhara, Jayasudha G. Gude, Rachel E. Fargason, Srinagesh Mannekote Thippaiah, Badari Birur |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cinacalcet Lithium (medication) Catatonia medicine.medical_treatment Parathyroid hormone Case Report 030209 endocrinology & metabolism Gastroenterology Diseases of the endocrine glands. Clinical endocrinology hyperparathyroidism 03 medical and health sciences 0302 clinical medicine Electroconvulsive therapy Internal medicine medicine PTH parathyroid hormone Blood urea nitrogen Calcium metabolism Hyperparathyroidism business.industry hypercalcemia General Medicine RC648-665 medicine.disease ECT electroconvulsive therapy lithium 030220 oncology & carcinogenesis catatonia business medicine.drug |
| Zdroj: | AACE Clinical Case Reports, Vol 7, Iss 3, Pp 189-191 (2021) AACE Clinical Case Reports |
| ISSN: | 2376-0605 |
| DOI: | 10.1016/j.aace.2020.12.010 |
| Popis: | Objective To familiarize the medical community with the less common adverse effects of lithium on parathyroid function, we present a case of lithium-associated hyperparathyroidism followed by the development of new-onset catatonia in a patient with schizoaffective disorder. Methods To allow for the safe resumption of lithium, the patient received laboratory screening of serum lithium, blood urea nitrogen, serum creatinine, calcium, and thyroid-stimulating hormone levels. The hypercalcemia was evaluated by measuring parathyroid hormone (PTH), ionized calcium, and 25-hydroxy vitamin D levels. Results A 58-year-old man with longstanding schizoaffective disorder was admitted for worsening psychotic symptoms following noncompliance with his risperidone and lithium regimen. Exploratory laboratory tests (hospital day 5) showed an elevated PTH level of 72 (reference, 15-65) pg/mL, ionized calcium level of 1.4 (reference, 1.03-1.23) mmol/mL, and a serum calcium level of 11.3 (reference, 8.4-10.5) mg/dL. After the discontinuation of lithium (day 6), anergia (day 7), mutism, and posturing (day 10) developed. Worsening catatonic symptoms of negativism and poor oral intake necessitated dehydration management with intravenous isotonic saline (day 24). The hypercalcemia persisted for 6 weeks. Treatment with cinacalcet (day 43) rapidly normalized the serum calcium levels (day 44). The catatonia, depression, and psychosis began resolving when clozapine (day 50) and electroconvulsive therapy (day 59) were initiated. PTH levels did not normalize until day 82. Conclusion This report describes a case of prolonged hyperparathyroidism and hypercalcemia following treatment with lithium. Catatonia is unusual in patients with lithium-associated hyperparathyroidism but this report suggests that in settings yet to be determined, it is related to hypercalcemia of this syndrome. |
| Databáze: | OpenAIRE |
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