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Mania in a Case of Hyperparathyroidism

Received January 5, 2006; revised July 25, 2006; accepted August 8, 2006. From Eastern Virginia Medical School, Dept. of Psychiatry and Behavioral Sciences, Norfolk, VA. Send correspondence and reprint requests to David R. Spiegel, M.D., Eastern Virginia Medical School, Dept. of Psychiatry and Behavioral Sciences, 825 Fairfax Ave., Norfolk, VA 23507. e-mail: spiegedr{at}evms.edu

Psychiatric manifestations of primary hyperparathyroidism are mediated by hypercalcemia. To date, most evidence indicates that hypercalcemia and increased cerebrospinal-fluid calcium levels produce depression symptoms. Presented here is a case report of a 52-year-old woman in a manic state. She had no psychiatric history but had substantially elevated parathyroid hormone levels and hypercalcemia. On the basis of emerging evidence that calcium channel-blockers effectively treat mania, the authors propose that elevated calcium levels may act through multiple mechanisms or on various regions of the brain to produce a spectrum of psychiatric symptoms that should now include mania as a possibility.

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