What are the signs and symptoms of primary hyperparathyroidism?

Updated: Dec 24, 2020
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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The clinical syndrome of primary hyperparathyroidism can be easily remembered as "bones, stones, abdominal groans, and psychic moans." With the introduction of routine measurement of blood calcium in the early 1970s, the most common clinical presentation of primary hyperparathyroidism changed from severe bone disease or kidney stones to asymptomatic hypercalcemia. [5]

Skeletal manifestations of primary hyperparathyroidism include primarily a selective cortical bone loss. Bone and joint pain, pseudogout, and chondrocalcinosis have also been reported. In the early clinical descriptions of primary hyperparathyroidism, some patients developed a peculiar type of bone disease known as osteitis fibrosa cystica, which was characterized by increased generalized osteoclastic bone resorption. Radiographic plain film changes associated with osteitis fibrosa cystica include subperiosteal resorption in the phalanges and a finding known as salt and pepper skull. This presentation is rarely seen today except in medically underserved populations.

Renal manifestations include polyuria, kidney stones, hypercalciuria, and rarely nephrocalcinosis.

Gastrointestinal manifestations include vague abdominal pain, anorexia, nausea, vomiting, constipation, peptic ulcer disease, and acute pancreatitis.

Neuromuscular and psychologic manifestations include fatigue, muscle weakness, depression, inability to concentrate, and memory problems or subtle deficits that are often characterized poorly and may not be noted by the patient, a common description being “brain fog." These symptoms are often attributed to aging, and some patients are diagnosed with chronic fatigue syndrome or fibromyalgia.

Cardiovascular manifestations include hypertension, bradycardia, shortened QT interval, and left ventricular hypertrophy. [6]

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