Do current screening recommendations allow for early detection of lithium-induced hyperparathyroidism in patients with bipolar disorder?

Springer Science and Business Media LLC - Tập 1 - Trang 1-8 - 2013
Michael Berger1, Michael Riedel1,2, Nora Tomova1,3, Michael Obermeier1, Florian Seemüller1, Sandra Dittmann1, Hans-Jürgen Moeller1, Emanuel Severus4
1Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians Universität München Nussbaumstrasse 7, Munich, Germany
2Abt. Psychiatrie, Vinzenz von Paul Hospital, Rottweil, Germany
3Isar-Amper Klinikum München-Ost Vockestrasse 72, Haar, Germany
4Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus Technische Universität Dresden, Dresden, Germany

Tóm tắt

Current screening recommendations for early detection of lithium-associated hyperparathyroidism propose an exclusive measurement of serum albumin-adjusted calcium (Aac) concentration as a single first step. However, longitudinal data in patients with recurrent affective disorders suggest that increases in serum intact parathyroid hormone (iPTH) levels in lithium-treated patients may not necessarily be accompanied by a parallel increase in the concentration of Aac. If true, patients with an isolated increase in iPTH concentration above the reference range might be missed following current screening recommendations. Therefore, this study set out to examine key parameters of calcium metabolism, including iPTH and 25-hydroxycholecalciferol concentrations in patients with bipolar disorder that was or was not managed with lithium. Sixty patients with bipolar disorder according to DSM-IV were enrolled, 30 of whom had received long-term lithium treatment (lithium group), whereas the other 30 patients were on psychopharmacological treatment not including lithium (non-lithium group) at the time of the study. Owing to exclusion criteria (e.g., lithium < 6 months, laboratory results indicative of secondary hyperparathyroidism), 23 bipolar patients composed the final lithium group, whereas 28 patients remained in the non-lithium group for statistical analyses. Patients in the lithium group showed a significantly higher concentration of iPTH compared to the non-lithium group (p < 0.05). Similarly, Aac concentrations were significantly increased in the lithium group compared to the non-lithium group (p < 0.05). However, in a multivariate linear regression model, group affiliation only predicted iPTH concentration (p < 0.05). In line with this, none of the four patients in the lithium group with an iPTH concentration above the reference range had an Aac concentration above the reference range. This study suggests that the biochemical characteristics between primary hyperparathyroidism and lithium-induced hyperparathyroidism differ substantially with regard to regulation of calcium homeostasis. As such, current screening practice does not reliably detect iPTH concentrations above the reference range. Therefore, further research is needed to elucidate the consequences of an isolated iPTH concentration above the reference range in order to develop the most appropriate screening tools for hyperparathyroidism in lithium-treated patients with bipolar disorder.

Tài liệu tham khảo

Ali FE, Al-Bustan MA, Al-Busairi WA, Al-Mulla FA: Loss of seizure control due to anticonvulsant-induced hypocalcemia. Ann Pharmacother 2004,38(6):1002–5. 10.1345/aph.1D467 Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry. 1961, 4: 561–71. 10.1001/archpsyc.1961.01710120031004 Broome JT, Solorzano CC: Lithium use and primary hyperparathyroidism. Endocr Pract 2011,17(Suppl 1):31–5. Driessen M, Wetterling T, Wedel T, Preuss R: Secondary hyperparathyroidism and depression in chronic renal failure. Nephron 1995,70(3):334–39. 10.1159/000188614 Durazo-Arvizu RA, Dawson-Hughes B, Sempos CT, Yetley EA, Looker AC, Cao G, Harris SS, Burt VL, Carriquiry AL, Picciano MF: Three-phase model harmonizes estimates of the maximal suppression of parathyroid hormone by 25-hydroxyvitamin D in persons 65 years of age and older. J Nutr 2010,140(3):595–99. 10.3945/jn.109.116681 Enns MW, Larsen DK, Cox BJ: Discrepancies between self and observer ratings of depression. The relationship to demographic, clinical and personality variables. J Affect Disord 2000,60(1):33–41. 10.1016/S0165-0327(99)00156-1 Fiedorowicz JG, Palagummi NM, Forman-Hoffman VL, Miller DD, Haynes WG: Elevated prevalence of obesity, metabolic syndrome, and cardiovascular risk factors in bipolar disorder. Ann Clin Psychiatry 2008,20(3):131–37. 10.1080/10401230802177722 Geddes JR, Goodwin GM, Rendell J, Azorin JM, Cipriani A, Ostacher MJ, Morriss R, Alder N, Juszczak E: Lithium plus valproate combination therapy versus monotherapy for relapse prevention in bipolar I disorder (BALANCE): a randomised open-label trial. Lancet 2010,375(9712):385–95. Goldberg JF, Brooks JO III, Kurita K, Hoblyn JC, Ghaemi SN, Perlis RH, Miklowitz DJ, Ketter TA, Sachs GS, Thase ME: Depressive illness burden associated with complex polypharmacy in patients with bipolar disorder: findings from the STEP-BD. J Clin Psychiatry 2009,70(2):155–62. 10.4088/JCP.08m04301 Gregoor PS, de Jong GM: Lithium hypercalcemia, hyperparathyroidism, and cinacalcet. Kidney Int 2007,71(5):470. 10.1038/sj.ki.5002065 Grof P, Alda M, Grof E, Fox D, Cameron P: The challenge of predicting response to stabilising lithium treatment. The importance of patient selection. Br J Psychiatry Suppl. 1993, 21: 16–9. Haden ST, Stoll AL, McCormick S, Scott J, Fuleihan GE: Alterations in parathyroid dynamics in lithium-treated subjects. J Clin Endocrinol Metab 1997,82(9):2844–48. 10.1210/jc.82.9.2844 Hagstrom E, Hellman P, Larsson TE, Ingelsson E, Berglund L, Sundstrom J, Melhus H, Held C, Lind L, Michaëlsson K, Arnlöv J: Plasma parathyroid hormone and the risk of cardiovascular mortality in the community. Circulation 2009,119(21):2765–71. 10.1161/CIRCULATIONAHA.108.808733 Hamilton M: Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967,6(4):278–96. 10.1111/j.2044-8260.1967.tb00530.x Hermsen D, Franzson L, Hoffmann JP, Isaksson A, Kaufman JM, Leary E, Müller C, Nakatsuka K, Nishizawa Y, Reinauer H, Riesen W, Roth HJ, Steinmüller T, Troch T, Bergmann P: Multicenter evaluation of a new immunoassay for intact PTH measurement on the Elecsys System 2010 and 1010. Clin Lab 2002,48(3–4):131–41. Hong L, Newton H, Nance M: Management of lithium-associated hyperparathyroidism. Aust NZ J Psychiatry 2012,46(6):585. 10.1177/0004867412445394 Hoogendijk WJ, Lips P, Dik MG, Deeg DJ, Beekman AT, Penninx BW: Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry 2008,65(5):508–12. 10.1001/archpsyc.65.5.508 Hornik K: Frequently Asked Questions on R [Internet]. Vienna (Austria): The Comprehensive R Archive Network; 2012. [cited 2013 February 20]. Available from: http://CRAN.R-project.org/doc/FAQ/R-FAQ.html Jaddou HY, Batieha AM, Khader YS, Kanaan SH, El-Khateeb MS, Ajlouni KM: Depression is associated with low levels of 25-hydroxyvitamin D among Jordanian adults: results from a national population survey. Eur Arch Psychiatry Clin Neurosci 2012,262(4):321–27. 10.1007/s00406-011-0265-8 Jorde R, Waterloo K, Saleh F, Haug E, Svartberg J: Neuropsychological function in relation to serum parathyroid hormone and serum 25-hydroxyvitamin D levels. The Tromso Study. J Neurol. 2006,253(4):464–70. 10.1007/s00415-005-0027-5 Kessing LV, Hellmund G, Geddes JR, Goodwin GM, Andersen PK: Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study. Br J Psychiatry 2011,199(1):57–63. 10.1192/bjp.bp.110.084822 Kim SH, Lee JW, Choi KG, Chung HW, Lee HW: A 6-month longitudinal study of bone mineral density with antiepileptic drug monotherapy. Epilepsy Behav 2007,10(2):291–95. 10.1016/j.yebeh.2006.11.007 Livingstone C, Rampes H: Lithium: a review of its metabolic adverse effects. J Psychopharmacol 2006,20(3):347–55. Mak TW, Shek CC, Chow CC, Wing YK, Lee S: Effects of lithium therapy on bone mineral metabolism: a two-year prospective longitudinal study. J Clin Endocrinol Metab 1998,83(11):3857–59. 10.1210/jc.83.11.3857 Roman SA, Sosa JA, Mayes L, Desmond E, Boudourakis L, Lin R, Holt E, Udelsman R: Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism. Surgery 2005,138(6):1121–28. 10.1016/j.surg.2005.08.033 Saunders BD, Saunders EF, Gauger PG: Lithium therapy and hyperparathyroidism: an evidence-based assessment. World J Surg 2009,33(11):2314–23. 10.1007/s00268-009-9942-4 Schleicher J, Kampf D: Lithium-induced endocrine changes [Internet]. Germany: International Group for the Study of Lithium Treated Patients; 2013. [cited 2013 February 20]. Available from: http://www.igsli.org/general.html Schneibel R, Brakemeier EL, Wilbertz G, Dykierek P, Zobel I, Schramm E: Sensitivity to detect change and the correlation of clinical factors with the Hamilton Depression Rating Scale and the Beck Depression Inventory in depressed inpatients. Psychiatry Res 2012,198(1):62–7. 10.1016/j.psychres.2011.11.014 Severus E, Schaaff N, Moller HJ: State of the art: treatment of bipolar disorders. CNS Neurosci Ther 2012,18(3):214–8. 10.1111/j.1755-5949.2011.00258.x Shlapack MA, Rizvi AA: Normocalcemic primary hyperparathyroidism-characteristics and clinical significance of an emerging entity. Am J Med Sci 2012,343(2):163–66. 10.1097/MAJ.0b013e31823bbb9b Silverberg SJ, Bilezikian JP: “Incipient” primary hyperparathyroidism: a “forme fruste” of an old disease. J Clin Endocrinol Metab 2003,88(11):5348–52. 10.1210/jc.2003-031014 Sitges-Serra A, Bergenfelz A: Clinical update: sporadic primary hyperparathyroidism. Lancet 2007,370(9586):468–70. 10.1016/S0140-6736(07)61213-6 Sloand JA, Shelly MA: Normalization of lithium-induced hypercalcemia and hyperparathyroidism with cinacalcet hydrochloride. Am J Kidney Dis 2006,48(5):832–37. 10.1053/j.ajkd.2006.07.019 Souberbielle JC, Friedlander G, Cormier C: Practical considerations in PTH testing. Clin Chim Acta 2006,366(1–2):81–9. Spearing MK, Post RM, Leverich GS, Brandt D, Nolen W: Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Res 1997,73(3):159–71. 10.1016/S0165-1781(97)00123-6 Suk JH, Cho EH, Lee SY, Kim JW: Laboratory evaluation of bone metabolism index using Elecsys 2010. Korean J Lab Med 2006,26(3):146–52. 10.3343/kjlm.2006.26.3.146 Suppes T, Leverich GS, Keck PE, Nolen WA, Denicoff KD, Altshuler LL, McElroy SL, Rush AJ, Kupka R, Frye MA, Bickel M, Post RM: The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients. J Affect Disord 2001,67(1–3):45–59. Vestergaard P, Rejnmark L, Mosekilde L: Reduced relative risk of fractures among users of lithium. Calcif Tissue Int 2005,77(1):1–8. 10.1007/s00223-004-0258-y Weisler RH, Nolen WA, Neijber A, Hellqvist A, Paulsson B: Continuation of quetiapine versus switching to placebo or lithium for maintenance treatment of bipolar I disorder (Trial 144: a randomized controlled study). J Clin Psychiatry 2011,72(11):1452–64. 10.4088/JCP.11m06878 Wittchen HU, Zaudig M, Frydrich T: Strukturiertes Klinisches Interview für DSM-IV (Achse I und II). Göttingen: Hogrefe Verlag für Psychologie; 1997. Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978, 133: 429–35. 10.1192/bjp.133.5.429 Zhao G, Ford ES, Li C, Balluz LS: No associations between serum concentrations of 25-hydroxyvitamin D and parathyroid hormone and depression among US adults. Br J Nutr 2010,104(11):1696–702. 10.1017/S0007114510002588