Lithium is one of the oldest known metals. It has multiple functions, but it was not until the 1940s that it was successfully used in the treatment of severe manic depression by John Cade, now regarded as the father of modern psychopharmacology. Side effects in the form of electrolyte imbalance, in particular hypercalcemia, were later suggested in 1973. Since then, over 300 surgical cases are reported in English literature regarding the treatment of lithium-induced hyperparathyroidism (LHPT). Whether LHPT is to be considered as a separate endocrinopathy is largely unknown and still debated. We elaborate on these issues, including potential mechanisms instigating LHPT, its biochemical profile and potential strategies for optimal medical and surgical management.