A case of acute psychosis in an adolescent male.

Ghufran Babar,Ramin Alemzadeh

doi:10.1155/2014/937631

Abstract

Primary hyperparathyroidism (PHPT) is a disorder of calcium homeostasis. We report the case of a 17-year-old adolescent male, who presented with an acute psychosis coinciding with severe hypercalcemia and markedly elevated intact parathyroid hormone (iPTH) level and low vitamin D level. A Sestamibi scan showed a positive signal inferior to the left lobe of the thyroid gland. He had only a partial response to the initial medical and psychiatric management. The enlarged parathyroid gland was resected surgically and postoperatively serum calcium and iPTH levels normalized. The histopathology was compatible with a benign adenoma. Patient's acute psychotic symptoms resolved gradually after surgery; however he remained under psychiatric care for the behavioral issues for about 6 months after surgery. While psychosis is a rare clinical manifestation of hypercalcemia secondary to PHPT in pediatric population, it should be considered as a clinical clue in an otherwise asymptomatic pediatric patient.

Highlights

Primary hyperparathyroidism (PHPT) is a disorder of calcium homeostasis. It is rare in pediatric population and is usually caused by a single parathyroid adenoma (PA) [1,2,3]
The patient had been admitted with acute psychosis a week prior to his transfer to Children’s Hospital of Wisconsin (CHW), where on a routine laboratory screening he was found to have serum calcium of 16.5 mg/dL
In PHPT, decreased percent tubular reabsorption of phosphate (TRP) usually results in low serum phosphate [25]; in some instances serum phosphate levels may fall in the low normal range as observed in our patient.Our patient’s serum intact parathyroid hormone (iPTH) and calcium levels normalized after the parathyroidectomy

Summary

Case Report A Case of Acute Psychosis in an Adolescent Male

Primary hyperparathyroidism (PHPT) is a disorder of calcium homeostasis. We report the case of a 17-year-old adolescent male, who presented with an acute psychosis coinciding with severe hypercalcemia and markedly elevated intact parathyroid hormone (iPTH) level and low vitamin D level. A Sestamibi scan showed a positive signal inferior to the left lobe of the thyroid gland. He had only a partial response to the initial medical and psychiatric management. The enlarged parathyroid gland was resected surgically and postoperatively serum calcium and iPTH levels normalized. While psychosis is a rare clinical manifestation of hypercalcemia secondary to PHPT in pediatric population, it should be considered as a clinical clue in an otherwise asymptomatic pediatric patient

Introduction

Findings

Laboratory results