Hypercalcemia and Hyperparathyroidism

Hypercalcemia and hyperparathyroidism are frequently under-diagnosed in psychiatric practice and there are recommendations that calcium levels should be monitored in patients on long‐term treatment.[1] Like with other electrolyte and fluid imbalances (see: hyponatremia, hypokalemia, hypomagnesemia, hypocalcemia),[2] hypocalcemia can cause neuropsychiatric symptoms.

Sequelae of long-term chronic hypercalcemia includes renal stones, osteoporosis, dyspepsia, hypertension and renal impairment. Symptoms of hypercalcemia (and consequently hyperparathyroidism) can also mimic as psychiatric disorders, with disturbances of mood, energy, and cognition.

Lithium increases the risk of hypercalcemia and hyperparathyroidism (prevalence of ~5%).[3] Up to 10% of patients on long-term lithium treatment develop hypercalcaemia and hyperparathyroidism, and this is even higher in the geriatric population.[4]