Primary hyperparathyroidism is a multi-systemic disorder. Many of the signs and symptoms are a result of the hypercalcemia caused by excessive parathyroid hormone. With modern biochemical testing it is often detected early in its course.


Renal changes:

(1) recurrent calcium nephrolithiasis, often with renal colic

(2) nephrocalcinosis

(3) impaired ability to concentration urine (with a dilute urine, nocturia and polyuria)

(4) acute renal failure


Gastrointestinal tract changes:

(1) nausea and vomiting

(2) peptic ulcer disease

(3) pancreatitis

(4) constipation

(5) adynamic ileus

(6) abdominal pain


Bone changes:

(1) increased osteoclastic activity with generalized demineralization of bone

(2) osteitis fibrosa cystica

(3) bone fracture

(4) bone pain

(5) bone cysts

(6) osteoclastomas ("brown tumors" composed of giant cells)

(7) bone deformities


Neuromuscular findings:

(1) generalized weakness

(2) proximal muscle weakness with abnormal gait

(3) apathy

(4) depression


Additional findings:

(1) band keratopathy

(2) conjunctival calcifications

(3) subperiosteal erosions around teeth

(4) hypertension


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