Lithium-Associated Hyperparathyroidism Followed by Catatonia
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 th...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | AACE Clinical Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060520311573 |
| _version_ | 1818640640915800064 |
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| author | Srinagesh Mannekote Thippaiah, MD Rachel E. Fargason, MD Jayasudha G. Gude, MD Shankarapura N. Muralidhara, MD Badari Birur, MD |
| author_facet | Srinagesh Mannekote Thippaiah, MD Rachel E. Fargason, MD Jayasudha G. Gude, MD Shankarapura N. Muralidhara, MD Badari Birur, MD |
| author_sort | Srinagesh Mannekote Thippaiah, MD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-16T23:14:29Z |
| format | Article |
| id | doaj.art-33f853655014497cbaac4a754d557ae7 |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-16T23:14:29Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-33f853655014497cbaac4a754d557ae72022-12-21T22:12:20ZengElsevierAACE Clinical Case Reports2376-06052021-05-0173189191Lithium-Associated Hyperparathyroidism Followed by CatatoniaSrinagesh Mannekote Thippaiah, MD0Rachel E. Fargason, MD1Jayasudha G. Gude, MD2Shankarapura N. Muralidhara, MD3Badari Birur, MD4Valleywise Behavioral Health- Maryvale, 5102 W Campbell Ave, Phoenix, Arizona; Address correspondence and reprint requests to Dr. Srinagesh Mannekote Thippaiah, Valleywise Behavioral Health-Maryvale, 5102 W Campbell Ave, Phoenix, AZ 85031.Valleywise Behavioral Health- Maryvale, 5102 W Campbell Ave, Phoenix, Arizona; Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AlabamaValleywise Behavioral Health- Maryvale, 5102 W Campbell Ave, Phoenix, Arizona; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, New YorkValleywise Behavioral Health- Maryvale, 5102 W Campbell Ave, Phoenix, Arizona; Park Nicollet Child and Family Behavioral Health Center, Saint Louis Park, MinnesotaValleywise Behavioral Health- Maryvale, 5102 W Campbell Ave, Phoenix, Arizona; Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AlabamaObjective: 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.http://www.sciencedirect.com/science/article/pii/S2376060520311573catatoniahypercalcemiahyperparathyroidismlithium |
| spellingShingle | Srinagesh Mannekote Thippaiah, MD Rachel E. Fargason, MD Jayasudha G. Gude, MD Shankarapura N. Muralidhara, MD Badari Birur, MD Lithium-Associated Hyperparathyroidism Followed by Catatonia AACE Clinical Case Reports catatonia hypercalcemia hyperparathyroidism lithium |
| title | Lithium-Associated Hyperparathyroidism Followed by Catatonia |
| title_full | Lithium-Associated Hyperparathyroidism Followed by Catatonia |
| title_fullStr | Lithium-Associated Hyperparathyroidism Followed by Catatonia |
| title_full_unstemmed | Lithium-Associated Hyperparathyroidism Followed by Catatonia |
| title_short | Lithium-Associated Hyperparathyroidism Followed by Catatonia |
| title_sort | lithium associated hyperparathyroidism followed by catatonia |
| topic | catatonia hypercalcemia hyperparathyroidism lithium |
| url | http://www.sciencedirect.com/science/article/pii/S2376060520311573 |
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