lithium-chloride and Hyperparathyroidism

Lithium-induced hyperparathyroidism is characterized by a reduction in parathyroid sensitivity to changes in extracellular calcium (Ca2+). Ca(2+)-induced transmembrane signal transduction in the parathyroid cell is known to result in the hydrolysis of phosphatidylinositol bisphosphate (PIP2), generating increases in intracellular inositol phosphates, a process which is mediated by a calcium receptor.. To determine if lithium's effect on parathyroid cell function is mediated by an alteration in Ca(2+)-induced hydrolysis of PIP2, inositol 4-monophosphate (IP1), and inositol 1,4,5-trisphosphate (IP3) were measured using anion-exchange chromatography in normal and lithium chloride (LiCl)-treated bovine parathyroid cells at Ca2+ concentrations varying from 0.5 mmol/L to 5.0 mmol/L. IP1 and IP3 concentrations were determined in terms of percent control, defined as the IP1 or IP3 concentration at an [Ca2+] of 0.5 mmol/L.. Increases in [IP1]/10(6) cells (mean +/- standard error of the mean [SEM]) in response to progressive increases in Ca2+ from 0.5 mmol/L to 5.0 mmol/L varied from 825 +/- 228 to 4,474 +/- 382 in control cells versus 1,139 +/- 243 to 4,689 +/- 630 in cells pretreated with LiCl (P > 0.05). The increases in [IP3]/10(6) cells (mean +/- SEM) in response to increases in Ca2+ from 0.5 mmol/L to 5.0 mmol/L, varied from 146 +/- 14 to 385 +/- 35 in control cells versus 134 +/- 16 to 327 +/- 55 in cells pretreated with LiCl (P > 0.05).. Our results demonstrate that LiCl does not effect Ca(2+)-induced hydrolysis of PIP2, suggesting that the desensitizing effect of LiCl on the parathyroid cell is not the result of a Ca2+ receptor-mediated phenomenon.

Topics: Animals; Animals, Newborn; Calcium; Cattle; Cell Membrane; Cells, Cultured; Chromatography, Ion Exchange; Dose-Response Relationship, Drug; Hydrolysis; Hyperparathyroidism; Inositol 1,4,5-Trisphosphate; Inositol Phosphates; Lithium Chloride; Parathyroid Glands; Phosphatidylinositol Phosphates; Phosphatidylinositols; Signal Transduction

Patients receiving lithium for the management of manic depressive disorders appear to be at increased risk for development of hypercalcemia. Some (but not all) clinical studies and several in vitro studies suggest that lithium alters release of parathyroid hormone. Because hypercalcemia may result from an increase in the mass of parathyroid tissue, we studied the in vitro effect of lithium on tritiated thymidine (3H-TdR) incorporation as a measure of DNA synthesis. Dispersed cells from previously cryopreserved tissue from 18 patients undergoing surgery for single-gland hyperparathyroidism (adenoma) and five patients with secondary hyperparathyroidism were incubated with graded concentrations of lithium chloride and, after a 5-day incubation, were pulsed with 3H-TdR. Adenoma cells exposed to 2.0 mmol/L lithium (therapeutic level is approximately 0.8 to 2.0 mmol/L) demonstrated increased 3H-TdR incorporation compared with cells not exposed to lithium (average increase 56%). Secondary hyperplasia cells exhibited a similar but less striking response. There was no lithium-induced 3H-TdR incorporation in four preparations with normal bovine parathyroid cells. We conclude that lithium in therapeutic doses increases 3H-TdR incorporation into adenoma cells, may serve as a mitogen for human parathyroid adenoma, and could promote or accelerate hyperparathyroidism.

Topics: Animals; Cattle; Cells, Cultured; Chlorides; DNA; Humans; Hyperparathyroidism; Lithium; Lithium Chloride; Parathyroid Glands; Thymidine; Tritium