Beyond Bipolar Disease: Primary Hyperparathyroidism in a Bipolar Patient

Abstract

Primary hyperparathyroidism consists of a dysregulated production of parathyroid hormone that results in abnormal calcium homeostasis. It is mostly detected in the asymptomatic phase; however, presentation may include a broad spectrum of clinical manifestations. We describe the case of a 67-year-old female patient with a previous history of bipolar disorder and several vascular risk factors who presented with generalized muscular weakness, anorexia and weight loss, polydipsia, nausea, constipation and mental confusion with behavioural change. Mental and behaviour changes were previously considered a cognitive deficit. Blood tests revealed severe acute renal injury, severe hypercalcemia and frankly increased parathyroid hormone. During hypercalcaemia study, cervical ultrasound identified a nodule compatible with parathyroid adenoma, coincident with hypercaptant focus on the sestamibi scintigraphy. Patient underwent treatment with zolendronic acid and posterior parathyroidectomy with gradual symptomatic and analytical improvement. The authors report this case recalling that psychiatric pathologies can delay the diagnosis of physical conditions.