Treatment of Parathyroid Adenoma in Lithium-Induced Primary Hyperparathyroidism

Patients receiving long-term lithium therapy can develop lithium-induced primary hyperparathyroidism (pHPT), a recognised complication in which a parathyroid adenoma drives sustained calcium dysregulation and requires specific surgical consideration.

Clinical Scenario

This protocol addresses parathyroid adenoma occurring in the specific context of lithium-induced primary hyperparathyroidism — a distinct subgroup among patients on prolonged lithium therapy, where standard surgical planning requires adaptation.

Approach & Goals

Management is surgical. The choice of operative technique is directed by preoperative imaging findings and real-time intraoperative monitoring — the full protocol defines the decision criteria and the conditions under which each surgical approach applies. The primary clinical endpoint is sustained restoration of normal calcium homeostasis. The complete algorithm is available via the protocol.

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References

DOI: 10.1001/jamasurg.2016.2310

In lithium-induced pHPT, the surgical approach may be BE or MIP guided by imaging and IPM.

Cure after parathyroidectomy is defined as the reestablishment of normal calcium homeostasis lasting a minimum of 6 months.

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