Lithium-associated hyperparathyroidism: Prevalence, Pathophysiology, Management

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Fältnamn	Indikatorer	Metadata
000		04147nam a2200361 4500
001		oai:DiVA.org:oru-65002
003		SwePub
008		180214s2018 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
020		a 9789175292342q print
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-650022 URI
040		a (SwePub)oru
041		a engb eng
042		9 SwePub
072	7	a vet2 swepub-contenttype
072	7	a dok2 swepub-publicationtype
100	1	a Meehan, Adrian,d 1973-u Örebro universitet,Institutionen för medicinska vetenskaper4 aut0 (Swepub:oru)anmn
245	1 0	a Lithium-associated hyperparathyroidism :b Prevalence, Pathophysiology, Management
264	1	a Örebro :b Örebro University,c 2018
300		a 70 s.
338		a electronic2 rdacarrier
490	0	a Örebro Studies in Medicine,x 1652-4063 ;v 174
520		a Lithium has been used in the treatment of bipolar disorder, formerly called manic depression, for nearly seven decades. Lithium-associated hyperparathyroidism (LHPT) is an ill-defined and less well known possible side-effect of chronic lithium therapy and was first described in 1973. The condition has been considered to be rare, though there exists conflicting evidence as to its prevalence, its pathophysiological background, and, if and when identified, what the appropriate medical or surgical treatment should be. The principal aim of this thesis was to understand and more comprehensively characterise this condition through studying a large patient cohort, with regards its prevalence, development, and additionally by providing an evaluation of surgical management up until now.In Study I a population of 423 lithium-treated out-patients (251 women, 172 men) were recruited from Jönköping and Örebro County. We found that 18% met the criteria for hyperparathyroidism (HPT) and that a further 21% had intermittent episodes of hypercalcaemia. We then examined, in Study II, the effects of lithium only in patients with bipolar disorder and compared them, firstly, to patients with bipolar disorder without lithium and, secondly, to a control population. In total, 563 individuals participated in the study. Hypercalcaemia was found to be strongly associated to lithium therapy (adjusted OR 13.45; 95% CI 3.09, 58.55; p=0.001). Study III is a descriptive study of calcium homeostasis in 297 lithium-treated patients from Jönköping where three main groups could be discerned: 178 were normocalcaemic (60%), 102 hypercalcaemic (34%), and 17 hypocalcaemic (6%). Many patients demonstrate robust fluctuations in serum calcium intermittently. Of those with suspected LHPT, 31% had urinary calcium excretion values be-low 1.2 mmol/24hrs. Study IV analysed surgical results of 78 parathyroidectomies in 71 patients with concurrent lithium therapy. In strong contrast to surgical outcomes in those with primary HPT, the overall cure-rate was lower (58%) and the predominant histological diagnosis was hyperplasia (52%). Two patients had double adenomas.Factors which should be particularly taken into consideration while monitoring lithium-treated patients are age, gender and lithium-duration.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
700	1	a Wallin, Göran,c Adjungerad professor,d 1952-u Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län4 ths0 (Swepub:oru)gwn
700	1	a Järhult, Johannes4 ths
700	1	a Wängberg, Bo,c Professoru Göteborgs universitet4 opn
710	2	a Örebro universitetb Institutionen för medicinska vetenskaper4 org
856	4	u https://oru.diva-portal.org/smash/get/diva2:1182631/PREVIEW01.pngx Previewy preview image
856	4	u https://oru.diva-portal.org/smash/get/diva2:1182631/COVER01.pdfy cover
856	4	u https://oru.diva-portal.org/smash/get/diva2:1182631/SPIKBLAD01.pdfy spikblad
856	4	u https://oru.diva-portal.org/smash/get/diva2:1182631/FULLTEXT01.pdfx primaryx Raw objecty fulltext
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-65002

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