Signs and Symptoms of Primary Hyperparathyroidism

Primary Hyperparathyroidism – Signs and Symptoms

Primary hyperparathyroidism is characterized by autonomous overproduction of PTH from one or more parathyroid glands → leading to hypercalcemia.
Symptoms arise due to elevated serum calcium, bone resorption, renal involvement, and neuromuscular/GI effects.

⭐ Mnemonic: "Stones, Bones, Groans, Thrones, and Psychiatric Overtones"
1. Renal Manifestations (“Stones”)

Caused by ↑ calcium excretion and nephrocalcinosis.

Nephrolithiasis (calcium oxalate/phosphate stones) – MOST common symptom

Nephrocalcinosis (deposition of calcium in renal parenchyma)

Polyuria & polydipsia (due to nephrogenic DI from hypercalcemia)

Dehydration

Reduced GFR, renal insufficiency

Hypertension (sometimes)

2. Skeletal/Bone Manifestations (“Bones”)

Due to ↑ PTH → ↑ osteoclastic bone resorption.

Osteopenia / Osteoporosis (especially cortical bone)

Subperiosteal bone resorption (classic sign on hand X-ray)

Bone pain

Brown tumors (osteitis fibrosa cystica)

Pathological fractures

3. Gastrointestinal Manifestations (“Groans”)

Hypercalcemia reduces smooth muscle tone → GI dysmotility.

Constipation

Nausea, vomiting

Abdominal pain

Peptic ulcer disease (due to ↑ gastrin stimulation)

Pancreatitis

Gallstones

4. Neuropsychiatric Manifestations (“Psychiatric Overtones”)

Due to hypercalcemia’s effect on the CNS.

Fatigue

Weakness

Depression

Cognitive dysfunction (memory issues, confusion)

Irritability

Personality changes

In severe cases: stupor, coma

5. Cardiovascular Manifestations

Shortened QT interval

Arrhythmias

Hypertension

Vascular/valvular calcification

6. Neuromuscular Symptoms

Muscle weakness

Proximal myopathy

Hyporeflexia

Fatigability

7. General Symptoms

Anorexia

Weight loss

Pruritus (rare)

Dehydration

✔ Asymptomatic Presentation (Common)

Up to 50% of PHPT patients are asymptomatic, detected incidentally on routine labs showing:

High calcium

High/normal PTH

Low phosphate