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International Journal of Bipolar Disorders

, 1:18

First Online: 16 September 2013Received: 10 July 2013Accepted: 13 August 2013

Abstract

BackgroundLithium-induced hyperparathyroidism LIH is a relative underrecognized complication of long-term lithium treatment. Hypercalcemia may be the first, but often overlooked, sign of LIH. Symptoms of LIH can be similar to the underlying psychiatric illness, which may cause a significant doctor’s delay in diagnosing LIH. The aim of this study was to determine the prevalence of hypercalcemia in a cohort of psychiatric patients.

MethodsIn this cross-sectional study, we collected data from 314 patients treated with lithium in an outpatient clinic for bipolar disorder. Patients with bipolar disorder from the same clinics, who had never been treated with lithium and of whom serum calcium levels were available, were included as controls n = 15. Patient characteristics and laboratory results were collected during the period of June 2010 till June 2011.

ResultsThe mean serum calcium level was 2.49 SD 0.11 mmol-l. The point prevalence of hypercalcemia >2.60 mmol-l was 15.6%. In a comparable group of psychiatric patients not using lithium, the mean serum calcium level was 2.37 mmol-l, and none of these patients had hypercalcemia p = 0.001. The duration of lithium treatment was the only significant predictor for the development of hypercalcemia p = 0.002.

DiscussionThe prevalence of hypercalcemia in lithium-treated patients was significantly higher than that in non-lithium treated controls and correlated to the cumulative time lithium was used in this cross-sectional study. We recommend that serum calcium levels should be routinely tested in patients using lithium for timely detection of LIH or hypercalcemia due to other causes.

KeywordsLithium Bipolar disorder Hypercalcemia Lithium-induced hyperparathyroidism Electronic supplementary materialThe online version of this article doi:10.1186-2194-7511-1-18 contains supplementary material, which is available to authorized users.

Bas A Twigt, Bernard M Houweling contributed equally to this work.

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