Lithium-Associated Hypercalcemia: Pathophysiology, Prevalence, Management.

Area of Science:

• Endocrinology
• Psychiatry
• Nephrology

Background:

• Lithium-associated hypercalcemia (LAH) is an under-recognized endocrine disorder.
• Bipolar patients (BP) are a key population for studying LAH.
• Lithium treatment in BP may increase the risk of hypercalcemia and hyperparathyroidism.

Purpose of the Study:

• To determine the prevalence of hypercalcemia in bipolar patients with and without lithium treatment.
• To investigate surgical outcomes for lithium-associated hyperparathyroidism.

Main Methods:

• Retrospective analysis of data from 313 BP on lithium, 148 BP not on lithium, and 102 controls.
• Logistic regression used to compare odds of hypercalcemia across groups.
• Surgical outcomes for patients with LAH were reviewed.

Main Results:

• The prevalence of LAH was 26% among bipolar patients on lithium.
• BP on lithium had significantly higher odds of hypercalcemia (aOR 13.45) compared to BP not on lithium.
• Seven BP on lithium underwent surgery for hyperparathyroidism, with high rates of hyperplasia and recurrence.

Conclusions:

• Regular monitoring of calcium homeostasis is recommended for patients on lithium, especially high-risk groups.
• Bilateral neck exploration should be considered for surgical management of LAH.
• Further prospective studies are warranted to investigate LAH.