Endocrine Abstracts

Lithium is considered a mainstay treatment option for the management of bipolar affective disorder. However, lithium administration is characterized by endocrine effects. The aim was to present the case of a patient who was on treatment with lithium for many years for the management of bipolar affective disorder and presented with a large parathyroid adenoma causing clinical hyperparathyroidism with severe hypercalcemia who was successfully treated by surgical excision of the adenoma and hypothyroidism. A patient, aged 68 years, presented with severe hypercalcemia, calcium levels on admission 13 mg/dl and difficulty in walking due to osteoporosis. PTH levels on admission were 300 pg/ml. After rehydration and diuretic treatment for the management of hypercalcemia, cinacalcet was administered at a dose of 30 mg twice daily for the management of hypercalcemia. Diagnostic evaluation revealed the presence of a large parathyroid adenoma situated inferiorly to the left thyroid lobe. Surgical treatment was undertaken and the parathyroid adenoma was successfully excised. Histology revealed a large cystic parathyroid adenoma. During follow up calcium levels normalised and the patient improved clinically. During follow up a TSH level of 6.7 mIU/l was noted. Thyroxine was administered. Lithium administration for the management of bipolar affective disorder is used successfully for many years. However, it may cause many endocrine effects. It may cause hypothyroidism and hypercalcemia due to hyperparathyroidism. Hypothyroidism is easily managed by thyroxine administration. However, hyperparathyroidism is usually due to one or more parathyroid adenomas or parathyroid hyperplasia. The optimum management of parathyroid adenomas in the case of long-term lithium treatment is surgical and usually controls hyperparathyroidism. In other reports most cases of hyperparathyroidism in the context of lithium treatment were due to one or more parathyroid adenomas. In conclusion, the case of a patient presenting with endocrine disease, namely primary hyperparathyroidism and hypothyroidism due to long term lithium administration is described. The disease was successfully treated with surgical excision of the parathyroid adenoma and thyroxine administration.