Lithium-associated hypercalcemia and hyperparathyroidism: A systematic review and meta-analysis.

Area of Science:

• Endocrinology
• Pharmacology
• Nephrology

Background:

• Lithium is a common mood stabilizer.
• Hyperparathyroidism is a potential complication of lithium therapy.
• Existing literature on this association requires synthesis.

Purpose of the Study:

• To systematically review and summarize human literature on lithium and hyperparathyroidism.
• To determine the prevalence of lithium-associated hypercalcemia (LAHca) through meta-analysis.

Main Methods:

• Systematic literature search using PRISMA guidelines (MEDLINE, Web of Science, Embase, Cochrane Library).
• Meta-analysis to calculate pooled prevalence of LAHca.
• Analysis of calcium and parathyroid hormone (PTH) levels.

Main Results:

• Pooled prevalence of LAHca was 3.17% (total calcium) and 4.23% (ionized calcium).
• Lithium use is linked to elevated calcium and PTH levels and increased hyperparathyroidism incidence.
• Multiglandular disease prevalence in LAH was 51.28%.

Conclusions:

• Lithium treatment elevates hyperparathyroidism risk, with a pooled prevalence around 4% versus 0.5% in the general population.
• Parathyroid surgery and cinacalcet are effective treatments for LAH.
• Evidence on lithium discontinuation for LAH resolution is anecdotal and conflicting.