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cl:hypercalcemia-hyperparathyroidism [on April 11, 2018]
 cl:hypercalcemia-hyperparathyroidism [on February 19, 2023] (current)
psychdb [Comparison]
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 +====== Hypercalcemia and Hyperparathyroidism ======
 +{{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. 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>​
 +
 +===== Causes =====
 +==== Lithium ====
 +<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>​