長期リチウム療法の内分泌および代謝上の課題:診断および管理上の検討

Stylianos Kopanos¹, Joachim Feldkamp¹

¹Academic Department of Endocrinology, Diabetes and Infectiology, Klinikum Bielefeld, Medical School and University Medical Centre East Westphalia-Lippe Bielefeld University, Bielefeld, DEU.

Cureus

|August 25, 2025

まとめ

双極性障害のリチウム治療は副甲状腺症や骨粗鬆症を引き起こす可能性がありますリチウム投与を中止すると患者のカルシウム濃度が正常化し骨の密度が改善され慎重に治療する必要があることが明らかになりました

科学分野:

内分泌学
精神科
骨の代謝

背景:

リチウムは双極性障害の重要な治療法ですが,その使用は内分泌および代謝問題,特にリチウム誘発性副甲状腺症 (LIH) と関連しています.
副甲状腺ホルモン (PTH) レベルが正常または上昇した高カルセミアで発現し,骨粗鬆症のような骨格合併症のリスクを高めます.
精神病患者のLIHの管理は,治療の遵守とフォローアップケアに伴う課題のために複雑です.

研究の目的:

リチウム誘発性副甲状腺症と骨粗鬆症の複雑な症例を記述する
治療耐性やアデランスの問題を含む診断と管理の課題を強調する.
LIHの管理に多学科的アプローチの必要性を強調する.

主な方法:

長期リチウム療法を受けた56歳の女性
評価には,検査 (カルシウム,PTH,ビタミンD) と画像検査 (甲状腺腺腫,骨粗鬆症) が含まれていた.
副甲状腺切除およびその後のリチウム投与中止後の評価結果

主要な成果:

再発性高カルセミア,副甲状腺症,骨粗鬆症,疲労と認知障害の症状を呈した患者.
甲状腺切除は高カルシウム症を治さなかった.リチウム投与を中止すると,カルシウムが正常化し,骨密度が改善した.
付着性の低下は管理を困難にし,フォローアップ画像では小さな上皮腺腫が認められた.

結論:

LIHの診断と治療は複雑で,特に精神疾患の併発症の場合です.
内分泌学と精神医学を統合した多学科アプローチは不可欠です.
最適な手術戦略,カルシミメティック療法,フォローアッププロトコルについては,さらなる研究が必要である.

キーワード:

カルシミメティック高カルセミアリチウム誘発性副甲状腺症ネフロゲン性糖尿病インシピドゥス骨粗鬆症

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