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Last edited on April 30, 2020

This shows you the differences between two versions of the page.

--- cl:hypercalcemia-hyperparathyroidism [on April 25, 2020]
+++ cl:hypercalcemia-hyperparathyroidism [on February 19, 2023] (current)
psychdb [Comparison]
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 {{INLINETOC}}
 ===== Primer =====
-**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.[([[https://www.ncbi.nlm.nih.gov/pubmed/25553494|Shapiro, H. I., & Davis, K. A. (2014). Hypercalcemia and “primary” hyperparathyroidism during lithium therapy. American Journal of Psychiatry, 172(1), 12-15.]])] Like with other electrolyte and fluid imbalances (see: [[cl:hyponatremia|hyponatremia]], [[cl:hypokalemia|hypokalemia]], [[cl:hypomagnesemia|hypomagnesemia]], [[cl:hypocalcemia|hypocalcemia]]),[([[https://www.ncbi.nlm.nih.gov/pubmed/7220784|Webb Jr, W. L., & Gehi, M. (1981). Electrolyte and fluid imbalance: neuropsychiatric manifestations. Psychosomatics, 22(3), 199-203.]])] hypocalcemia can cause neuropsychiatric symptoms.
+**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.[([[https://www.ncbi.nlm.nih.gov/pubmed/25553494|Shapiro, H. I., & Davis, K. A. (2014). Hypercalcemia and “primary” hyperparathyroidism during lithium therapy. American Journal of Psychiatry, 172(1), 12-15.]])] Like with other electrolyte and fluid imbalances (see: [[cl:hyponatremia|hyponatremia]], [[cl:hypokalemia|hypokalemia]], [[cl:hypomagnesemia|hypomagnesemia]], [[cl:hypocalcemia|hypocalcemia]]),[([[https://www.ncbi.nlm.nih.gov/pubmed/7220784|Webb Jr, W. L., & Gehi, M. (1981). Electrolyte and fluid imbalance: neuropsychiatric manifestations. Psychosomatics, 22(3), 199-203.]])] hypocalcemia can cause neuropsychiatric symptoms. Long-term lithium can cause hypercalcemia and hyperparathyroidism.
 ===== Signs and 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.
+<callout icon="fa fa-lightbulb-o" type="success" title="Mnemonic">
+The mnemonic ''painful bones'' (abnormal bone remodeling), ''renal stones'' (kidney stones from hypercalciuria), ''abdominal groans'' (hypercalcemia-induced ileus and abdominal pain), ''thrones'' (urinary frequency), and ''psychic moans'' ([[mood:1-depression:home|depression]]) can be used to recall the common symptoms of hypercalcemia.
+</callout>
-===== Pathophysiology =====
+===== Causes =====
 ==== Lithium ====
-Lithium increases the risk of hypercalcemia and hyperparathyroidism (prevalence of ~5%).[([[https://www.ncbi.nlm.nih.gov/pubmed/22985484|Lehmann, S. W., & Lee, J. (2013). Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: What do we know?. Journal of affective disorders, 146(2), 151-157.]])] Up to 10% of patients on long-term lithium treatment develop hypercalcaemia and hyperparathyroidism, and this is even higher in the geriatric population.[([[https://www.ncbi.nlm.nih.gov/pubmed/22985484|Lehmann, S. W., & Lee, J. (2013). Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: What do we know?. Journal of affective disorders, 146(2), 151-157.]])]
+<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">
+See main article: **[[meds:mood-stabilizers-anticonvulsants:1-lithium|]]**
+</alert>
+Lithium increases the risk of hypercalcemia and hyperparathyroidism (prevalence of ~5%).[([[https://www.ncbi.nlm.nih.gov/pubmed/22985484|Lehmann, S. W., & Lee, J. (2013). Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: What do we know?. Journal of affective disorders, 146(2), 151-157.]])] Lithium is thought to cause hyperparathyroidism due to it altering the set point of receptors that sense calcium in parathyroid cells, and thus causing excess parathyroid hormone release.[([[https://pubmed.ncbi.nlm.nih.gov/24083184/|Nair, C. G., Menon, R., Jacob, P., & Babu, M. (2013). Lithium-induced parathyroid dysfunction: A new case. Indian journal of endocrinology and metabolism, 17(5), 930.]])] Up to 10% of patients on long-term lithium treatment develop hypercalcaemia and hyperparathyroidism, and this is even higher in the geriatric population.[([[https://www.ncbi.nlm.nih.gov/pubmed/22985484|Lehmann, S. W., & Lee, J. (2013). Lithium-associated hypercalcemia and hyperparathyroidism in the elderly: What do we know?. Journal of affective disorders, 146(2), 151-157.]])]
+==== Other ====
+Hyperparathyroidism can occur due to primary, secondary, or tertiary causes. Primary causes include parathyroid adenomas, and carcinomas. Secondary causes include decreased calcium absorption, vitamin D deficiency, and chronic kidney disease. Tertiary causes include refractory hyperparathyroidism from chronic renal disease.
+===== Comparison =====
+<panel type="info" title="Comparison of Various Electrolyte Disturbances" subtitle="" no-body="true" footer="">
+<mobiletable 1>
+^            ^ Hypo (Low Concentration)                                                                                          ^ Hyper (High Concentration)                                                                                                                                 ^
+^ Sodium     | [[cl:hyponatremia|Hyponatremia]]: Nausea, malaise, stupor, coma, seizures                                                             | Irritability, stupor, coma                                                                                                                                 |
+^ Potassium  | [[cl:hypokalemia|Hypokalemia]]: Arrhythmias, muscle cramps, spasm, and weakness. ECGs will show U waves and flattened T waves        | Arrhythmias, muscle weakness. ECGs will show Wide QRS and peaked T waves.                                                                                  |
+^ Calcium    | [[cl:hypocalcemia|Hypocalcemia]]: Tetany, seizures, QT prolongation, twitching (e.g. - Chvostek sign), spasm (e.g. - Trousseau sign)  | [[cl:hypercalcemia-hyperparathyroidism|Hypercalcemia]]: Stones (renal), bones (pain), groans (abdominal pain), thrones (urinary frequency), psychiatric overtones (anxiety, altered mental status)  |
+^ Magnesium  | [[cl:hypomagnesemia|Hypomagnesmia]]: Tetany, torsades de pointes, hypokalemia, hypocalcemia                                             | Decreased deep tendon reflexes, hypotension, lethargy, bradycardia,  cardiac arrest, hypocalcemia                                                          |
+^ Phosphate  | Bone loss, osteomalacia (adults), rickets (children)                                                              | Renal stones, metastatic calcifications, hypocalcemia                                                                                                      |
+</mobiletable>
+</panel>
+<imgcaption image1|>{{ :cl:hyperparathyroidism.jpg?nolink&800 |Hyperparathyroidism}}</imgcaption>
+===== Treatment =====
+If hyperparathyroidism is thought to be due to lithium, then stopping lithium is the definitive treatment for reversing symptoms of hyperparathyoidism. Otherwise, a parathyroidectomy is the only cure for hyperparathyroidism.
+===== Resources =====
+<WRAP group>
+<WRAP quarter column>
+== For Patients ==
+</WRAP>
+<WRAP quarter column>
+== For Providers ==
+  * **[[https://www.nature.com/articles/nrdp201755|Mannstadt, M. et al. (2017). Hypoparathyroidism. Nature Reviews Disease Primers, 3(1), 1-21.]]**
+  * **[[https://www.nature.com/articles/nrdp201633|Bilezikian, J. et al. Primary hyperparathyroidism. Nature Reviews Disease Primers, 2, 16033 (2016)]]**
+</WRAP>
+<WRAP quarter column>
+== Articles ==
+</WRAP>
+<WRAP quarter column>
+== Research ==
+</WRAP>
+</WRAP>