New Onset Depression From Unknown Cause
A 47-year-old male with a clean medical history presented to a psychiatrist with new onset depression. There was no family history of depression. The patient was married with three children, owned his own garage business, and worked as a car mechanic. He reported a stable and happy family life. Until recently, he had been doing well.
The psychiatrist prescribed antidepressant medication, but his patient was not responding to several different drug treatment regimens. As a result of the depression, the patient was unable to work, and had to move out of his home due to anger management issues and deteriorating behavior.
Two years later, at age 49, the patient was seen by his family physician. A routine laboratory work-up including biochemistry data revealed high calcium of 16 mmol/L and low phosphate of 6 mmol/L. Measurement of endocrine data disclosed high parathyroid hormone levels. He was referred to an endocrinologist and then to an endocrine surgeon. A parathyroidectomy was performed. Within six months the patient recovered from his depression and was back to work.
Often patients with hyperparathyroidism wander through the corridors of medical offices between various specialists with depression and/or behavior problems. If the diagnosis of hyperparathyroidism is not made in a timely manner, the patient can lose his or her job and family. A medical malpractice claim can be brought on behalf of patients who have been misdiagnosed with depression without specific cause when a reasonably thorough evaluation would have pointed to hyperparathyroidism.
The parathyroid glands are most commonly four pea-sized glands. Anatomically they are attached to the back of the thyroid gland and its capsule. They produce the parathyroid hormone, PTH or parathormone. This hormone maintains physiological levels of calcium and phosphates in the serum and blood. Aberrations in the production of this hormone can cause serious illnesses, including kidney stones, gallbladder disease, mental disease, and cardiovascular disease. The remedy starts with a proper diagnosis and is typically followed by parathyroidectomy.
