A Case of Acute Psychosis in an Adolescent Male

Abstract EN

Primary hyperparathyroidism (PHPT) is a disorder of calcium homeostasis.

We report the case of a 17-year-old adolescent male, who presented with an acute psychosis coinciding with severe hypercalcemia and markedly elevated intact parathyroid hormone (iPTH) level and low vitamin D level.

A Sestamibi scan showed a positive signal inferior to the left lobe of the thyroid gland.

He had only a partial response to the initial medical and psychiatric management.

The enlarged parathyroid gland was resected surgically and postoperatively serum calcium and iPTH levels normalized.

The histopathology was compatible with a benign adenoma.

Patient’s acute psychotic symptoms resolved gradually after surgery; however he remained under psychiatric care for the behavioral issues for about 6 months after surgery.

While psychosis is a rare clinical manifestation of hypercalcemia secondary to PHPT in pediatric population, it should be considered as a clinical clue in an otherwise asymptomatic pediatric patient.