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Background: Long-term lithium use in psychiatric patients may lead to lithium associated hyperparathyroidism LAH. Although anecdotal case reports have appeared, an evidence based algorithm for management of LAH is lacking. Methods: A comprehensive literature search was performed 1973-2010 using PubMed with keywords; -lithium-hypercalcemia-hyperparathyroidism-sestamibi-intra-operative parathyroid hormone IOPTH monitoring-parathyroidectomy- and -medical management-. All English language publications addressing etiology and clinical management issues concerning LAH were critically analyzed. Results: Lithium associated hyperparathyroidism occurs in 4.3% - 6.3% of chronic lithium users compared to the general population which has an incidence of 0.5% - 1%. 194 cases of LAH have been reported which includes 10 patients 5% treated medically and 170 patients 88% who underwent parathyroidectomy. No details were available for 14 patients 7%. Among parathyroidectomy patients, 104 59% had adenomatous disease and 66 39% had multiglandular hyperplasia. Preoperative localization studies were utilized in only 22 patients 13% and IOPTH monitoring was reported in only 3 studies 32 patients, 19%. Among surgical patients, bilateral neck exploration BNE was the most common approach performed in 162 patients 95%; focused neck exploration was utilized in only 8 patients 5%. Parathyroidectomy normalized LAH biochemical changes in nearly all patients 90% - 97% in the early post-operative period, but recurrent hyperparathyroidism occurred in 8% - 42% of patients. Conclusion: LAH is an under appreciated and poorly understood endocrine disorder. LAH has a higher incidence of multiglandular disease and bilateral neck exploration is mandatory in majority for disease control. Nonsurgical approaches may be useful in select patients on short-term lithium therapy.

KEYWORDS

Lithium, Hypercalcemia, Hyperparathyroidism, Sestamibi Intra-Operative Parathyroid Hormone IOPTH Monitoring, Parathyroidectomy, Medical Management

Cite this paper

U. Ballehaninna, S. Nguyen and R. Chamberlain -Lithium Associated Hyperparathyroidism: An Evidence Based Surgical Approach,- Surgical Science, Vol. 2 No. 10, 2011, pp. 468-475. doi: 10.4236-ss.2011.210103.





Author: Umashankar K Ballehaninna, Steven M. Nguyen, Ronald S. Chamberlain

Source: http://www.scirp.org/



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