Lithium-Associated Hyperparathyroidism Followed by Catatonia: Case Report
Out on PubMed is this case report:
Lithium-Associated Hyperparathyroidism Followed by Catatonia.
AACE Clin Case Rep. 2020 Dec 19;7(3):189-191. doi: 10.1016/j.aace.2020.12.010. eCollection 2021 May-Jun.PMID: 34095485
The abstract is copied below:
Objective: To familiarize the medical community with the less common adverse effects of lithium on parathyroid function, we present a case of lithium-associated hyperparathyroidism followed by the development of new-onset catatonia in a patient with schizoaffective disorder.
Methods: To allow for the safe resumption of lithium, the patient received laboratory screening of serum lithium, blood urea nitrogen, serum creatinine, calcium, and thyroid-stimulating hormone levels. The hypercalcemia was evaluated by measuring parathyroid hormone (PTH), ionized calcium, and 25-hydroxy vitamin D levels.
Results: A 58-year-old man with longstanding schizoaffective disorder was admitted for worsening psychotic symptoms following noncompliance with his risperidone and lithium regimen. Exploratory laboratory tests (hospital day 5) showed an elevated PTH level of 72 (reference, 15-65) pg/mL, ionized calcium level of 1.4 (reference, 1.03-1.23) mmol/mL, and a serum calcium level of 11.3 (reference, 8.4-10.5) mg/dL. After the discontinuation of lithium (day 6), anergia (day 7), mutism, and posturing (day 10) developed. Worsening catatonic symptoms of negativism and poor oral intake necessitated dehydration management with intravenous isotonic saline (day 24). The hypercalcemia persisted for 6 weeks. Treatment with cinacalcet (day 43) rapidly normalized the serum calcium levels (day 44). The catatonia, depression, and psychosis began resolving when clozapine (day 50) and electroconvulsive therapy (day 59) were initiated. PTH levels did not normalize until day 82.
Conclusion: This report describes a case of prolonged hyperparathyroidism and hypercalcemia following treatment with lithium. Catatonia is unusual in patients with lithium-associated hyperparathyroidism but this report suggests that in settings yet to be determined, it is related to hypercalcemia of this syndrome.
Keywords: ECT, electroconvulsive therapy; PTH, parathyroid hormone; catatonia; hypercalcemia; hyperparathyroidism; lithium.
The pdf is here.
This is an interesting, but unconvincing, case report. I will leave it to blog followers to read the entire case and come to your own conclusions. Seems to me that newly-initiated high dose aripiprazole and olanzapine might well have been the cause of the catatonia, and not necessarily the lithium-induced hyperparathyroidism/hypercalcemia.
In any case, the catatonia resolved with ECT, as is typical.
This case report is a reminder that lithium doesn't just affect the thyroid. The report is also a good review of calcium metabolism.
Finally, here is an unrelated lithium factoid:
Lithium increases platelet count.
N Engl J Med. 1984 Sep 6;311(10):674-5. doi: 10.1056/NEJM198409063111016.PMID: 6433195
So, lithium has stimulatory effects on red cell, as well as white cell lines...
Please do read the case in its entirety, ~10 minutes.
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