Hyperparathyroidism Initial Assessment

The majority of patients are asymptomatic, and diagnosis is often made after an incidental finding of elevated parathyroid hormone or serum calcium. The presence of signs and symptoms depends on the severity of the disease and is usually related to elevated levels of parathyroid hormone and serum calcium. Severe cases of hyperparathyroidism resulting in hypercalcemia can lead to rapid kidney failure, loss of consciousness, coma, or life-threatening cardiac abnormalities (eg shortening of the QT interval, bradycardia, hypertension).  

Signs and Symptoms  

Classical manifestations of primary hyperparathyroidism include bone (eg fractures, cysts, osteitis fibrosa cystica) and renal (eg nephrolithiasis, nephrocalcinosis) disease. Other signs and symptoms are constipation, muscle weakness, nausea and vomiting, polydipsia and polyuria, neuropsychiatric symptoms (eg decreased concentration, confusion, fatigue, stupor, coma, depression, anxiety), loss of appetite, hypophosphatemia, increased calcitriol production, proximal renal tubular acidosis, hypomagnesemia, hyperuricemia and gout, and anemia. 

A complete history should be gathered, including surgical procedures, medical conditions, and medications (eg thiazides, Lithium).

The physical examination may be unremarkable, as there are no specific physical findings. Parathyroid adenomas are rarely palpable and deposition of calcium phosphate in the cornea, known as band keratopathy, is rare and only seen when calcium and phosphate levels are high.