Catatonia Induced by Lithium-Associated Hyperparathyroidism

This case describes a 62-year-old female who developed catatonia induced by lithium-associated hyperparathyroidism. The objective is to highlight the potential link between lithium-induced hyperparathyroidism and catatonia, emphasizing the diagnostic and management challenges.

A 62-year-old female with bipolar disorder, on intermittent lithium since 2010, was hospitalized after a fall. Laboratory results confirmed lithium-induced hyperparathyroidism. On hospital day 9, she developed symptoms and signs of catatonia, including moaning, unresponsiveness, and waxy flexibility, along with a peak serum calcium level of 12.1 mg/dL. Despite treatment with lorazepam and electroconvulsive therapy, her catatonia persisted. On day 31, lithium was discontinued, and intravenous zoledronic acid was administered. Her serum calcium dropped to 9.4 mg/dL, and by day 36, significant clinical improvement was noted.

Lithium-associated hyperparathyroidism can cause a range of symptoms, including fatigue, constipation, and nephrolithiasis. Severe cases may present with catatonia, though this is rarely reported. This case underscores the potential connection between lithium-induced hyperparathyroidism and catatonia, even with moderate hypercalcemia.

Our case highlights the importance of recognizing and managing lithium-induced hyperparathyroidism in patients presenting with catatonia.