Appropriate surgical treatment of lithium-associated hyperparathyroidism.
BACKGROUND
Lithium is frequently used in the treatment of bipolar disease. Although lithium-associated hyperparathyroidism (LAH) is well documented, reports concerning its pathologic findings are sparse. Because of a high-reported incidence of multiglandular disease, focused exploration for LAH is controversial.


METHODS
From 1995 to 2007, data from 1207 consecutive patients who underwent concise parathyroid exploration for sporadic primary hyperparathyroidism (PHP) directed by quick intraoperative parathyroid hormone monitoring (QPTH) were reviewed to identify patients with LAH. Anatomic findings were determined. All patients had >5 months of follow-up.


RESULTS
The incidence of LAH was 16/1207 (1.3%). The rate of multiglandular disease was not higher in LAH: present in 25% (4/16) patients with LAH and 12.3% (146/1191) patients without LAH (p = 0.13 Fisher two-tailed test). Among 16 patients with LAH, 12 (75%) had a single adenoma. The use of QPTH allowed unilateral exploration in 8 of 12 patients with single adenoma. Parathyroid exploration resulted in durable biochemical cure for all 16 patients with LAH.


CONCLUSIONS
Multiglandular disease seems to be no more frequent in patients with LAH than in patients with primary hyperparathyroidism (PHP) without LAH. Patients with LAH can be safely and effectively managed with selective unilateral exploration directed by intraoperative PTH monitoring.
Carchman
Evie
E
Department of General Surgery, UPMC, 200 Lothrop Street, Pittsburgh, PA 15213, USA. carchmaneh@upmc.edu
Ogilvie
Jennifer
J
Holst
Jennifer
J
Yim
John
J
Carty
Sally
S
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery; D018692:Antimanic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000139:chemically induced / Q000601:surgery*; D018020:Lithium Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D018692:Antimanic Agents; D018020:Lithium Compounds; D010281:Parathyroid Hormone