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Hyperparathyroidism associated with treatment of manic-depressive disorders by lithium
J Nordenström1, K Strigård, L Perbeck
1Department of Surgery, Huddinge University Hospital, Sweden.
Objective:
To clarify the association between treatment of affective psychiatric disorders with lithium, and the development of secondary hyperparathyroidism.
Design:
Retrospective review of medical records, 1973-89.
Subjects:
17 patients with affective psychiatric disorders who were treated with lithium (n = 6) or with tricyclic antidepressant, or neuroleptic, drugs (n = 11) all of whom were operated on for hyperparathyroidism.
Main Outcome Measure:
Duration of lithium therapy and parathyroid histology.
Results:
Parathyroid hyperplasia was present in 5 patients who had taken lithium during a median period of 13 years. A parathyroid adenoma was found in one patient treated with lithium for three years. Ten of the 11 patients who had been treated with tricyclic antidepressant, or neuroleptic drugs had a parathyroid adenoma and the remaining one had an adenoma as an underlying cause of hyperparathyroidism.
Conclusion:
Hyperparathyroidism in patients who have undergone long term treatment with lithium is associated with parathyroid hyperplasia. This indicates that lithium may exert a chronic stimulus that results in secondary hyperparathyroidism.