++
For further information, see CMDT Part 26-16: Hyperparathyroidism
+++
Essentials of Diagnosis
++
Frequently detected incidentally by routine blood testing
Kidney stones, polyuria, hypertension, constipation, fatigue, mental changes
Bone pain
Elevated serum parathyroid hormone (PTH), serum and urine calcium, and urine phosphate
Serum phosphate low to normal
Alkaline phosphatase normal to elevated
+++
General Considerations
++
++
Most common cause of hypercalcemia, with an estimated prevalence of 0.89% of the population in the United States
Occurs at all ages but most commonly in the seventh decade and in women (74%)
Before age 45, the prevalence is similar in men and women
More prevalent in Black adults than in other individuals
++
Frequently asymptomatic
Symptoms include problems with "bones, stones, abdominal groans, psychic moans, fatigue overtones"
Bone pain and arthralgias are common
Severe, chronic hyperparathyroidism can cause diffuse demineralization, pathologic fractures, and cystic bone lesions throughout the skeleton, a condition known as osteitis fibrosa cystica
Postmenopausal women are prone to asymptomatic vertebral fractures
Mild hypercalcemia
May be asymptomatic
However, symptom severity is not entirely predicted by the level of serum calcium or PTH, so even mild hypercalcemia can cause significant symptoms, particularly depression, constipation, and bone and joint pain
Hypercalcemic manifestations include
Neuromuscular: paresthesias, muscle cramps and weakness, and diminished deep tendon reflexes
Neuropsychiatric: malaise, headache, fatigue, insomnia, irritability, depression, intellectual weariness, cognitive impairment, disorientation, psychosis, or stupor
Cardiovascular: hypertension; palpitations; ECG findings of prolonged P-R interval, shortened Q-T interval, sensitivity to arrhythmic effects of digitalis, bradyarrhythmias, heart ...