Signs and Symptoms of Primary Hyperparathyroidism

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About this video

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# ⭐ **Primary Hyperparathyroidism – Signs & Symptoms (Complete Clinical Overview)**

Primary hyperparathyroidism = **autonomous overproduction of PTH** (usually due to a **single parathyroid adenoma**) → **hypercalcemia** → multisystem manifestations.

Clinical features are mainly due to **high calcium**, **high PTH**, and **bone resorption**.

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# 🔶 **Mnemonic: “Bones, Stones, Groans & Psychic Overtones”**

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# ✅ **1. Musculoskeletal (BONES)**

**Mechanism:** PTH stimulates osteoclast activity → bone resorption → decreased bone mineral density.

**Symptoms:**

* Diffuse **bone pain**
* **Osteoporosis** (especially distal radius, hip, spine)
* **Osteitis fibrosa cystica** (rare but classic; subperiosteal resorption, brown tumors)
* **Muscle weakness**
* **Joint aches / myalgias**

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# ✅ **2. Renal (STONES)**

**Mechanism:** Hypercalcemia → increased urinary calcium → stones.

**Symptoms:**

* **Nephrolithiasis (kidney stones)** – calcium oxalate/phosphate
* **Nephrocalcinosis**
* **Polyuria** and **polydipsia** (impaired concentrating ability)
* **Dehydration**
* Chronic disease → **CKD**

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# ✅ **3. Gastrointestinal (GROANS)**

**Mechanism:** High calcium affects smooth muscle + pancreatic function + secretions.

**Symptoms:**

* **Constipation**
* **Nausea / vomiting**
* **Abdominal pain**
* **Peptic ulcer disease** (increased gastrin)
* **Pancreatitis** (hypercalcemia activates pancreatic enzymes)
* **Loss of appetite / weight loss**

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# ✅ **4. Neuropsychiatric (PSYCHIC OVERTONES)**

**Mechanism:** Calcium affects neuronal excitability.

**Symptoms:**

* **Fatigue**
* **Depression**
* **Anxiety / irritability**
* **Cognitive dysfunction** (“brain fog”)
* **Memory impairment**
* Severe hypercalcemia → **confusion**, **lethargy**, **coma**

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# ✅ **5. Cardiovascular Signs**

* **Hypertension**
* **Shortened QT interval** on ECG
* Arrhythmias (rare; severe hypercalcemia)
* Vascular and valvular **calcifications**

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# ✅ **6. General / Non-specific Symptoms**

* **Excessive thirst**
* **Generalized weakness**
* **Bone fractures** (low-impact)
* **Pruritus** (rare)

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# ⭐ **Classic Picture**

A middle-aged woman with:

* Recurrent **renal stones**
* **Bone pain** or fragility fractures
* **Fatigue**, **depression**, **constipation**
* Serum **calcium ↑**, **PTH ↑**, **phosphate ↓**, **ALP ↑**

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