Endocrine Abstracts

A 74 year old lady presently to casualty with generalized ill health, vomiting and a mechanical fall. She was well known to the psychiatry team with severe depressive disorder managed with Lithium. Clinical examination was unremarkable. Baseline blood tests confirmed hyperparathyroidism with corrected calcium of 3.24 mmol/l and high parathyroid hormone levels of 13.4 pmol/L. Lithium levels were normal. She improved clinically with intravenous hydration followed by pamidronate infusion. Outpatient investigations including neck ultrasound, planar Sestamibi scan, CT neck and thorax with contrast, SPECT MIBI and SPECT CT all failed to localize parathyroid adenoma. The diagnosis is most likely hyperparathyroidism secondary to Lithium therapy. Withdrawal of Lithium and trial of different anti-psychotic agents resulted in relapse of her mental disorder requiring hospitalization and the need for Electro-convulsive therapy. She is now maintained on 400 mg of Lithium daily and her mental condition is stable. She has CKD stage 3 and osteoporosis and we plan to undertake neck exploration with a view to excise single or multiple gland adenomas or three and a half gland resection if there is evidence of parathyroid hyperplasia. Lithium is well known to cause single/multiple parathyroid gland adenomas as well as four gland hyperplasia and this case serves as a reminder of this association and the challenge in the management of such patients.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.