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Acute Psychosis in the Setting of Undiagnosed Normocalcemic Hyperparathyroidism: A Case Report

Hyperparathyroidism (HPT) causes an elevation of parathyroid hormone (PTH). This can result in elevated calcium levels, which can cause bone, kidney, muscle, gastrointestinal, and neuropsychiatric symptoms, including psychosis. Our report presents a unique case of an elderly woman who presented to t...

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Autores principales: El-Husari, Ali, Phrathep, Davong D, Ibrahim, Mohamed, Chism, Danielle, Narvel, Ravish
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076081/
https://www.ncbi.nlm.nih.gov/pubmed/37033554
http://dx.doi.org/10.7759/cureus.35840
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author El-Husari, Ali
Phrathep, Davong D
Ibrahim, Mohamed
Chism, Danielle
Narvel, Ravish
author_facet El-Husari, Ali
Phrathep, Davong D
Ibrahim, Mohamed
Chism, Danielle
Narvel, Ravish
author_sort El-Husari, Ali
collection PubMed
description Hyperparathyroidism (HPT) causes an elevation of parathyroid hormone (PTH). This can result in elevated calcium levels, which can cause bone, kidney, muscle, gastrointestinal, and neuropsychiatric symptoms, including psychosis. Our report presents a unique case of an elderly woman who presented to the emergency department in an unconscious state with a working diagnosis of metabolic encephalopathy secondary to sepsis and urinary tract infection. Despite fluids and antibiotic treatment, the patient showed hallucinations. The acuteness of her psychotic episodes prompted the medical team to further investigate the cause of her hallucinations. Additional labs revealed HPT, which she had never been diagnosed with prior to the hospital admission. Our patient’s novel clinical presentation revealed elevated PTH and normal calcium levels as the cause of her psychosis. We determined that the normal calcium levels were due to the patient’s calcium loss secondary to acute kidney injury. Cinacalcet administration showed resolution of the patients' hallucinations, highlighting the importance of PTH screening even in normocalcemic patients. In this report, we present a rare clinical presentation of acute psychosis in the setting of undiagnosed normocalcemic HPT.
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spelling pubmed-100760812023-04-06 Acute Psychosis in the Setting of Undiagnosed Normocalcemic Hyperparathyroidism: A Case Report El-Husari, Ali Phrathep, Davong D Ibrahim, Mohamed Chism, Danielle Narvel, Ravish Cureus Endocrinology/Diabetes/Metabolism Hyperparathyroidism (HPT) causes an elevation of parathyroid hormone (PTH). This can result in elevated calcium levels, which can cause bone, kidney, muscle, gastrointestinal, and neuropsychiatric symptoms, including psychosis. Our report presents a unique case of an elderly woman who presented to the emergency department in an unconscious state with a working diagnosis of metabolic encephalopathy secondary to sepsis and urinary tract infection. Despite fluids and antibiotic treatment, the patient showed hallucinations. The acuteness of her psychotic episodes prompted the medical team to further investigate the cause of her hallucinations. Additional labs revealed HPT, which she had never been diagnosed with prior to the hospital admission. Our patient’s novel clinical presentation revealed elevated PTH and normal calcium levels as the cause of her psychosis. We determined that the normal calcium levels were due to the patient’s calcium loss secondary to acute kidney injury. Cinacalcet administration showed resolution of the patients' hallucinations, highlighting the importance of PTH screening even in normocalcemic patients. In this report, we present a rare clinical presentation of acute psychosis in the setting of undiagnosed normocalcemic HPT. Cureus 2023-03-06 /pmc/articles/PMC10076081/ /pubmed/37033554 http://dx.doi.org/10.7759/cureus.35840 Text en Copyright © 2023, El-Husari et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Endocrinology/Diabetes/Metabolism
El-Husari, Ali
Phrathep, Davong D
Ibrahim, Mohamed
Chism, Danielle
Narvel, Ravish
Acute Psychosis in the Setting of Undiagnosed Normocalcemic Hyperparathyroidism: A Case Report
title Acute Psychosis in the Setting of Undiagnosed Normocalcemic Hyperparathyroidism: A Case Report
title_full Acute Psychosis in the Setting of Undiagnosed Normocalcemic Hyperparathyroidism: A Case Report
title_fullStr Acute Psychosis in the Setting of Undiagnosed Normocalcemic Hyperparathyroidism: A Case Report
title_full_unstemmed Acute Psychosis in the Setting of Undiagnosed Normocalcemic Hyperparathyroidism: A Case Report
title_short Acute Psychosis in the Setting of Undiagnosed Normocalcemic Hyperparathyroidism: A Case Report
title_sort acute psychosis in the setting of undiagnosed normocalcemic hyperparathyroidism: a case report
topic Endocrinology/Diabetes/Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076081/
https://www.ncbi.nlm.nih.gov/pubmed/37033554
http://dx.doi.org/10.7759/cureus.35840
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