A Case of Lithium Induced Hyperparathyroidism

A 76-year-old white female with a history of bipolar illness, chronically managed on lithium, presented altered mental status in the context normal pressure hydrocephalus. She exhibited signs catatonia autonomic instability including uncontrolled hypertension and isolated episodes tachycardia. Bush Francis catatonic rating scale score was 21, which highly suggestive catatonia; however, she did not respond to Ativan challenge suggested an encephalopathy, classical catatonia. Labs revealed apparent primary hyperparathyroidism associated hypercalcemia elevated PTH setting longterm lithium use.