Abstract
Lithium is the treatment of choice for acute manic, mixed, and depressive episodes of bipolar disorder, along with long-term prophylaxis. A significant proportion of patients taking lithium develop lithium-associated hypercalcemia. Most cases are due to lithium-associated hyperparathyroidism with underlying parathyroid adenoma or hyperplasia. We present a 67-year-old woman who presented with increasing lethargy and loss of concentration and was found to have slightly raised serum calcium levels with inappropriately low urinary calcium excretion levels characteristic of hypocalciuric hypercalcemia. She had been on lithium therapy for over 15 years for bipolar disease. She had no other cause for these findings and had no family history to suggest familial hypocalciuric hypercalcemia. Neck imaging ruled out any parathyroid adenoma or hyperplasia. A diagnosis of lithium-associated hypocalciuric hypercalcemia was discussed with the patient, and she remains stable under surveillance.
Highlights
Lithium has been used for the treatment of bipolar disorder for more than 60 years, and current guidelines recommend lithium as the treatment of choice for acute manic, mixed, and depressive episodes of bipolar disorder, along with long-term prophylaxis [1,2]
We present a case of a female patient who developed lithium-associated hypocalciuric hypercalcemia (LAHH) while on long-term lithium therapy for bipolar disorder
We have described a patient with chronic mild hypercalcemia, slightly raised parathyroid hormone levels, and inappropriately low urinary calcium levels
Summary
Lithium has been used for the treatment of bipolar disorder for more than 60 years, and current guidelines recommend lithium as the treatment of choice for acute manic, mixed, and depressive episodes of bipolar disorder, along with long-term prophylaxis [1,2]. We present a case of a female patient who developed LAHH while on long-term lithium therapy for bipolar disorder. A 67-year-old Caucasian woman presented with a three-month history of feeling unwell with lethargy, increased thirst, and loss of concentration Her serum calcium level had been slightly raised in the six months prior to this presentation. Her medical history included bipolar disorder for over 15 years, for which she took lithium carbonate 600 mg daily, hypothyroidism for which she took levothyroxine 100 mcg daily, idiopathic pulmonary hypertension for which she took bosentan 125 mg twice a day, and obstructive sleep apnea for which she used a continuous positive airway pressure apparatus. The patient complained of ongoing tiredness, which could have been related to the chronic mild hypercalcemia
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