Hypercalcemia and Hyperparathyroidism

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.[1] Like with other electrolyte and fluid imbalances (see: hyponatremia, hypokalemia, hypomagnesemia, hypocalcemia),[2] hypocalcemia can cause neuropsychiatric symptoms.

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.

Pathophysiology

Lithium

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]

References

1) Shapiro, H. I., & Davis, K. A. (2014). Hypercalcemia and “primary” hyperparathyroidism during lithium therapy. American Journal of Psychiatry, 172(1), 12-15.
2) Webb Jr, W. L., & Gehi, M. (1981). Electrolyte and fluid imbalance: neuropsychiatric manifestations. Psychosomatics, 22(3), 199-203.
3) 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.
4) 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.