title: Lithium-Associated Hyperparathyroidism: A Pooled Analysis.
abstract: BACKGROUND
  Lithium treatment has been associated with hyperparathyroidism (HPT). However, there are conflicting data regarding the rate of single- (SGD) versus multiple-gland disease (MGD) as well as the optimum surgical approach in these cases.
  
  
  METHODS
  Published data were identified through systematic electronic literature searches. Studies that fulfilled the preset inclusion criteria were analyzed (n = 12).
  
  
  RESULTS
  These studies documented 210 lithium-associated HPT (LAH) cases. Of these, 103 (49%) were due to SGD and 107 (51%) due to MGD. The unadjusted odds ratio of having multiple LAH compared to sporadic HPT was 3.44 (95% confidence interval 2.5907-4.5633; p < 0.0001). The sensitivity of preoperative sestamibi and sonography for SGD was 66-100 and 75-82%, respectively. The sensitivity for MGD was 9-67% for both. Intraoperative parathyroid hormone monitoring was utilized in 6 studies. Three studies recommended minimally invasive parathyroidectomy (MIP), while the other 3 recommended bilateral exploration.
  
  
  CONCLUSIONS
  LAH is a relatively frequent condition among patients on lithium, and calcium monitoring should be performed initially and longitudinally. Almost half of the LAH cases are due to SGD. MIP should be the optimum surgical approach.
authors: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, La., USA.
authors: Yasin
authors: Y
authors: Ibrahim
authors: Salah Edin
authors: SE
authors: Mohamed
authors: Ahmed
authors: A
authors: Deniwar
authors: Zaid H
authors: ZH
authors: Al-Qurayshi
authors: Emad
authors: E
authors: Kandil
mesh_terms: D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery; D008094:Lithium / Q000009:adverse effects*; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods
chemical_list: D010281:Parathyroid Hormone; D008094:Lithium