Beyond Bipolar Disease: Primary Hyperparathyroidism in a Bipolar Patient

Carolina Paiva, Sandra Assunção, Sofia Moreira, Xenia Verraest, José Eduardo Sousa, Nuno Madureira, António Paiva, Andreia Vilas-Boas
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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.
超越双相疾病:双相患者的原发性甲状旁腺功能亢进
原发性甲状旁腺功能亢进包括甲状旁腺激素分泌失调,导致钙稳态异常。它大多在无症状期被发现;然而,表现可能包括广泛的临床表现。我们描述了一个67岁的女性患者,既往有双相情感障碍病史和几种血管危险因素,表现为全身肌肉无力、厌食和体重减轻、烦渴、恶心、便秘和精神错乱并伴有行为改变。精神和行为的改变以前被认为是一种认知缺陷。血液检查显示严重的急性肾损伤,严重的高钙血症和甲状旁腺激素明显升高。在高钙血症研究中,宫颈超声发现了一个与甲状旁腺瘤相容的结节,与sestamibi闪烁图上的高充血灶一致。患者接受唑来膦酸治疗和后甲状旁腺切除术,症状逐渐改善。作者报告这一情况,回顾精神病理可以延迟身体状况的诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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