Hostname: page-component-848d4c4894-ttngx Total loading time: 0 Render date: 2024-06-01T00:17:10.827Z Has data issue: false hasContentIssue false
  • English
  • Français

Hyperparathyroidism and Paranoid Psychosis

Case Report and Review of the Literature

Published online by Cambridge University Press:  29 January 2018

Renato D. Alarcón  and
José A. Franceschini
Renato D. Alarcón*
Affiliation:
School of Medicine, University of Alabama in Birmingham, 619 6th Avenue South, Birmingham, Alabama 35223, USA
José A. Franceschini
Affiliation:
School of Medicine, University of Alabama in Birmingham, 619 6th Avenue South, Birmingham, Alabama 35223, USA
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Summary

Literature on psychiatric manifestations of hyperparathyroidism published in the last four decades confirms the unusual features of a case of paranoid psychosis secondary to a parathyroid-adenoma-induced hypercalcaemia. Affective and organic symptoms are overwhelmingly dominant in hypercalcaemic patients; the majority of cases reported are women of 50 years or older, who have been vaguely ill for a prolonged time before the actual endocrinopathy appears. The severity of the psychiatric symptoms does not seem to be related to the degree of hypercalcaemia. Recent findings link the role of calcium and related ions in the production of psychopathological symptoms to membrane phenomena, dopaminergic activity, and neuroendocrine regulation.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 145 , Issue 5 , November 1984 , pp. 477 - 486
Copyright
Copyright © 1984 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agras, S. & Ouveau, D. C. (1964) Primary hyperparathyroidism and psychosis. Canadian Medical Association Journal, 91, 1366–7.Google Scholar
Alexander, P. E., Van Kammen, D. P. & Bunney, W. E. (1978) Serum calcium and magnesium in schizophrenia: I. Relationship to clinical phenomena and neuroleptic treatment. British Journal of Psychiatry, 133, 143–9.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. Washington, D.C.: The American Psychiatric Association.Google Scholar
Anderson, J. (1968) The psychiatric aspects of disturbed calcium metabolism. Proceedings of the Royal Society of Medicine, 61, 1123–4.Google ScholarPubMed
AthanAssenas, G., Papadopoulos, E., Kourkoubas, A. et al (1983) Serum calcium and magnesium levels in chronic schizophrenics. Journal of Clinical Psychopharmacology, 3, 212–16.CrossRefGoogle ScholarPubMed
Beiser, M. (1978) Psychiatric Epidemiology. In The Harvard Guide to Modern Psychiatry (ed. Nicholi, A. M.). Cambridge, Massachusetts: Belknap Press.Google Scholar
Bogdonoff, M. D., Woods, A. H., White, J. E. & Engel, F. L. (1956) Hyperparathyroidism. American Journal of Medicine, 14, 583–95.Google Scholar
Boyd, J. H. & Weissman, M. M. (1982) Epidemiology. In Handbook of Affective Disorders. (ed. Paykel, E. S.). New York: Guilford Press.Google Scholar
Brunk, F. (1954) Role of calcium ions in neural processes. Pharmacological Review, 6, 243–98.Google Scholar
Carman, J. S., Crews, E. L., Bancroft, A. et al (1980) Calcium and calcium-regulating hormones in the biphasic periodic psychoses. Journal of Operational Psychiatry, 11, 5–17.Google Scholar
Carman, J. S. & Wyatt, R. J. (1977) Alterations in CSF and serum total calcium with changes in psychiatric state. In Neuroregulators and Psychiatric Disorders. (eds. Usdin, E., Hamburg, D. A. and Barchas, J. D.). London: Oxford University Press.Google Scholar
Carman, J. S. (1979) Calcium: Pacesetting the periodic psychoses. American Journal of Psychiatry, 136, 1035–9.Google Scholar
Carman, J. S. (1979a) Use of calcitonin in psychotic agitation or mania. Archives of General Psychiatry, 36, 72–5.Google Scholar
Christie-Brown, J. R. W. (1968) Mood changes following parathyroidectomy. Proceedings of the Royal Society of Medicine, 61, 1121–3.Google Scholar
Cooper, A. F. & Schapira, K. (1973) Case Report: Depression, catatonic stupor, and EEG changes in hyperparathyroidism. Psychological Medicine, 3, 509–15.CrossRefGoogle ScholarPubMed
Cope, D. (1960) Hyperparathyroidism: Diagnosis and management. American Journal of Surgery, 99, 394–403.Google Scholar
Davson, H. (1967) Physiology of the Cerebrospinal Fluid. London: Churchill.Google Scholar
Deutsch, S. F. (1968) Recent contributions in psychoendocrinology. Psychosomatics, 9, 127–34.Google ScholarPubMed
Devaris, D. P. & Mehlman, I. (1979) Psychiatric presentations of endocrine and metabolic disorders. Primary Care, 6, 245–65.CrossRefGoogle ScholarPubMed
Dubovsky, S. L., Franks, R. D. Lifschitz, M. & Coen, P. (1982) Effectiveness of verapamil in the treatment of a manic patient. American Journal of Psychiatry, 139, 502–4.Google ScholarPubMed
Eitinger, L. (1942) Hyperparathyroidism with mental changes. Nordvik Medicine, 14, 1581–5.Google Scholar
Feldman, F., Mitchell, W. & Soll, S. (1968) Psychosis, Cushing's Syndrome and hyperparathyroidism. Canadian Medical Association Journal, 98, 508–11.Google Scholar
Fitz, T. E. & Hallman, B. L. (1952) Mental changes associated with hyperparathyroidism. A.M.A. Archives of Internal Medicine, 89, 547–51.CrossRefGoogle ScholarPubMed
Flanagan, T. A., Goodwin, D. W. & Anderson, P. (1970) Psychiatric illness in a large family with familial hyperparathyroidism. British Journal of Psychiatry, 117, 693–8.CrossRefGoogle Scholar
Gatewood, J. W., Organ, C. H. & Mead, B. T. (1975) Mental changes associated with hyperparathyroidism. American Journal of Psychiatry, 132, 129–32.Google ScholarPubMed
Geiderman, J. M., Goodman, S. L. & Cohen, D. B. (1979) Magnesium—the forgotten electrolyte. Journal of American College of Emergency Physicians, 8, 204–8.CrossRefGoogle ScholarPubMed
Hall, R. C. W. & Joffe, J. R. (1973) Hypomagnesemia. Physical and psychiatric symptoms. Journal of the American Medical Association, 224, 1749–51.Google ScholarPubMed
Haskett, R. F. & Rose, R. M. (1981) Neuroendocrine disorders and psychopathology. Psychiatric Clinics of North America, 4, 239–52.CrossRefGoogle ScholarPubMed
Hecht, A., Gershberg, H. & ST. Paul, H. (1975) Primary hyperparathyroidism. Laboratory and clinical data in 73 cases. Journal of the American Medical Association, 233, 519–26.Google ScholarPubMed
Hellstrom, J. & Ivermark, B. I. (1962) Primary hyperparathyroidism. Acta Chirurgica Scandinavica, Suppl. 294, 5–113.Google ScholarPubMed
Henson, R. A. (1966) The neurological aspects of hypercalcemia: with special reference to primary hyperparathyroidism. Journal of the Royal College of Physicians, London, 1, 41–50.Google ScholarPubMed
Hunter, G. & Smith, H. V. (1960) Calcium and magnesium in human cerebrospinal fluid. Nature, 186, 161–3.CrossRefGoogle ScholarPubMed
Jacobs, J. K. & Merrit, C. R. (1966) Magnesium deficiency in hyperparathyroidism: Case report of toxic psychosis. Annals of Surgery, 162, 260–2.Google Scholar
Jimerson, D. C., Post, R. M., Carman, J. S. et al (1979) CSF Calcium: Clinical correlates in affective illness and schizophrenia. Biological Psychiatry, 14, 37–51.Google Scholar
Karpati, G. & Frame, B. (1964) Neuropsychiatric disorders in primary hyperparathyroidism. Clinical analysis with review of the literature. Archives of Neurology, 10, 387–97.Google Scholar
Kendell, R. E. & Di Scipio, W. J. (1970) Obsessional symptoms and obsessional personality traits in patients with depressive illness. Psychological Medicine, 1, 65–72.Google Scholar
Killey, J. S., Kinjevic, K. & Somjen, G. (1969) Divalent cations and electrical properties of cortical cells. Journal of Neurobiology, 2, 197–201.Google Scholar
Kind, H. (1959) Psychische Störungen bei Hyperparathyreoidismus. Archives Psychiatrie Nervenkr., 200, 1–11.Google Scholar
Lehrer, G. & Levitt, M. (1960) Neuropsychiatric presentation of hypercalcemia. Journal of the Mount Sinai Hospital, 27, 10–18.Google ScholarPubMed
Lipowski, Z. J. (1980) A new look at organic brain syndromes. American Journal of Psychiatry, 137, 674–77.Google Scholar
Lishman, W. A. (1978) Organic Psychiatry. Oxford: Blackwell Scientific Publications.Google Scholar
Marks, C. (1968) Hyperparathyroidism and its clinical effects. A merican Journal of Surgery, 116, 40–8.Google ScholarPubMed
Massey, S. G. (1978) The clinical pathophysiology of magnesium. Controversies in Nephrology, 14, 64–73.Google Scholar
Mikkelsen, E. J. & Reider, A. A. (1979) Post-parathyroidectomy psychosis: Clinical and research implications. Journal of Clinical Psychiatry, 40, 352–7.Google ScholarPubMed
Morgenroth, V. H., Boadte-Biber, M. C. & Roth, R. (1975) Activation of tyrosine hydroxylase from central noradrenergic neurons by calcium. Molecular Pharmacology, 11, 427–35.Google Scholar
Nielsen, H. (1955) Familial occurrence, gastro-intestinal symptoms and mental disturbances in hyperparathyroidism. Acta Medica Scandinavica, 15, 359–66.Google Scholar
Noble, P. (1974) Depressive illness and hyperparathyroidism. Proceedings of the Royal Society of Medicine, 67, 1066–7.Google Scholar
Petersen, P. (1968) Psychiatric disorders in primary hyperparathyroidism. Journal of Clinical Endocrinology and Metabolism, 28, 1491–5.CrossRefGoogle ScholarPubMed
Pope, H. G. & Lipinski, J. F. (1978) Diagnosis in schizophrenia and manic-depressive illness. Archives of General Psychiatry, 35, 811–28.Google Scholar
Potts, J. T. (1980) Disorders of parathyroid glands. In Harrison's Principles of Internal Medicine, 5th Edition (eds. Isselbacher, K. J., Adams, R. D. et al). New York: McGraw-Hill.Google Scholar
Reilly, E. L. & Wilson, W. P. (1965) Mental symptoms in hyperparathyroidism (A report of three cases). Diseases of the Nervous System, 26, 361–3.Google ScholarPubMed
Reinfrank, R. F. (1961) Primary hyperparathyroidism with depression. Archives of Internal Medicine, 108, 162–6.Google Scholar
Reiser, M. F. & Whisnant, L. (1980) Endocrine Disorders. In Comprehensive Textbook of Psychiatry, 3rd Edition, Vol. 2, (eds. Kaplan, H. I., Freedman, A. M. & Sadock, B. J.). Baltimore, Maryland: Williams & Wilkins.Google Scholar
Rifkin, A. (ed.) (1983) Schizophrenia and Affective Disorders. Biology and Drug Treatment. Boston: John Wright, PSH.Google Scholar
Rosenblatt, S. & Faillace, L. A. (1977) Psychiatric manifestation of hyperparathyroidism. Texas Medicine, 73, 59–60.Google ScholarPubMed
Ross, D. H., Medina, M. A. & Cardenas, H. L. (1974) Morphine and ethanol: Selective depletion of regional brain calcium. Science, 186, 63–5.Google Scholar
Smith, C. K., Barish, J., Correa, J. & Williams, R. H. (1972) Psychiatric disturbance in endocrinologic disease. Psychosomatic Medicine, 34, 69–86.Google Scholar
Snyder, S. H. (1983) Molecular mechanisms of psychotropic drug action. Presented at a symposium on advances in psychiatric diagnosis and treatment, 136th American Psychiatric Association Annual Meeting, New York.Google Scholar
St. Goar, W. T. (1957) Gastrointestinal symptoms as a clue to the diagnosis of primary hyperparathyroidism: A review of 45 cases. Annals of Internal Medicine, 102–18.Google Scholar
Thomas, W. C., Wiswell, J. G., Conncr, T. B. & Howard, J. E. (1958) Hypercalcemie crisis due to hyperparathyroidism. American Journal of Medicine, 16, 229–39.Google Scholar
Watson, L. (1968) Clinical aspects of hyperparathyroidism. Proceedings of the Royal Society of Medicine, 61, 1123–6.Google Scholar
Whybrow, P. C. & Hurwitz, T. (1976) Psychological disturbances associated with endocrine disease and hormone therapy. In Hormones, Behavior, and Psychopathology. (ed. Sachar, E. J.). New York: Raven Press.Google Scholar
Zales, M. R. (ed.) (1983) Affective and Schizophrenic Disorders. New approaches to diagnosis and treatment. New York: Brunner Mazel.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.