Prolonged Hypercalcemia-Induced Psychosis

Hypercalcemia is known to cause neuropsychiatric dysfunction including mood and cognitive changes and rarely, acute psychosis.High calcium levels can be a catalyst for neuronal demise, possibly due to glutaminergic excitotoxicity and dopaminergic andserotonergic dysfunction. While restoration of normal calcium levels or removal of a parathyroid adenoma has been shown torapidly resolve neuropsychiatric symptoms, there have been rare reported cases of primary hyperparathyroid-relatedhypercalcemia with persistent symptoms of psychosis. In this case report, we will describe a patient with no past psychiatrichistory presenting with a protracted course of delirium and psychosis after a removal of a parathyroid adenoma which hadcaused prolonged exposure to hypercalcemia. The patient’s psychosis was unresponsive to psychotropic medication andrequired inpatient psychiatric care after medical clearance. Per medical records, before the patient was ultimately lost to follow-up, she continued to suffer from psychotic symptoms for at least 8 months. We will discuss the patient’s unusual hospital courseand management and offer suggestions for future study.