Editing Hyperparathyroidism (section)

==Signs and symptoms==
In primary hyperparathyroidism, about 75% of people are "asymptomatic".<ref name="Fraser-2009" /> While most primary patients are asymptomatic at the time of diagnosis, 'asymptomatic' is poorly defined and represents only those without "obvious clinical sequelae" such as kidney stones, bone disease, or hypercalcemic crisis.<ref name="McDow-2018" />  These "asymptomatic" patients may have other symptoms such as depression, anxiety, gastrointestinal distress, and neuromuscular problems that are not counted as symptoms.<ref name="McDow-2018" />  The problem is often picked up incidentally during [[Blood test|blood work]] for other reasons, and the test results show a higher amount of calcium in the blood than normal.<ref name="Michels-2013" /> Many people only have [[non-specific symptoms]].<ref>{{Cite journal |last=Taniegra |first=Edna D. |date=2004-01-15 |title=Hyperparathyroidism |url=https://www.aafp.org/pubs/afp/issues/2004/0115/p333.html |journal=American Family Physician |language=en-US |volume=69 |issue=2 |pages=333–339|pmid=14765772 }}</ref>

Common manifestations of hypercalcemia include [[constipation]], [[vomiting]], weakness, lethargy, fatigue, depression, bone pain, muscle soreness ([[myalgia]]s), joint pain, decreased appetite, feelings of [[nausea]], abdominal pain, [[pancreatitis]], [[polyuria]], [[polydipsia]], cognitive impairment, [[kidney stone]]s ({{#tag:ref |Although [[parathyroid hormone]] (PTH) promotes the reabsorption of calcium from the kidneys' tubular fluid, thus '' decreasing'' the rate of urinary calcium excretion, its effect is only noticeable at any given plasma ionized calcium concentration. The primary determinant of the amount of calcium excreted into the urine per day is the plasma ionized calcium concentration.  Thus, in primary hyperparathyroidism, the quantity of calcium excreted in the urine per day is ''increased'' despite the high levels of PTH in the blood, because hyperparathyroidism results in [[hypercalcemia]], which increases the urinary calcium concentration ([[hypercalcuria]]). [[Kidney stone]]s are, therefore, often a first indication of hyperparathyroidism, especially since the hypercalcuria is accompanied by an increase in urinary [[phosphate]] excretion (a direct result of the high plasma PTH levels). Together, the calcium and phosphate tend to precipitate out as water-insoluble salts, which readily  form solid “stones”.<ref name="Blaine-2015">{{cite journal | vauthors = Blaine J, Chonchol M, Levi M | title = Renal control of calcium, phosphate, and magnesium homeostasis | journal = Clinical Journal of the American Society of Nephrology | volume = 10 | issue = 7 | pages = 1257–72 | date = July 2015 | pmid = 25287933 | pmc = 4491294 | doi = 10.2215/CJN.09750913 }}</ref><ref name="Harrison-1958">{{cite book| vauthors = Harrison TR, Adams RD, Bennett Jr IL, Resnick WH, Thorn GW, Wintrobe MM |title = Principles of Internal Medicine.|edition= Third|date=1958|publisher=McGraw-Hill Book Company.|location=New York| pages=575–578| chapter=Metabolic and Endocrine Disorders. }}</ref> |group=nb}}), vertigo and [[osteopenia]] or [[osteoporosis]].<ref>[http://www.endocrine.niddk.nih.gov/pubs/hyper/hyper.htm#symptoms Hyperparathyroidism] {{webarchive|url=https://web.archive.org/web/20110524101254/http://www.endocrine.niddk.nih.gov/pubs/hyper/hyper.htm |date=2011-05-24 }}. National Endocrine and Metabolic Diseases Information Service. May 2006.</ref><ref>{{cite journal | vauthors = McKenna K, Rahman K, Parham K | title = Otoconia degeneration as a consequence of primary hyperparathyroidism | journal = Medical Hypotheses | volume = 144 | pages = 109982 | date = November 2020 | pmid = 32531542 | doi = 10.1016/j.mehy.2020.109982 }}</ref> A history of acquired [[racquet nail]]s (brachyonychia) may be indicative of bone resorption.<ref>{{cite journal | vauthors = Baran R, Turkmani MG, Mubki T | title = Acquired racquet nails: a useful sign of hyperparathyroidism | journal = Journal of the European Academy of Dermatology and Venereology | volume = 28 | issue = 2 | pages = 257–9 | date = February 2014 | pmid = 23682576 | doi = 10.1111/jdv.12187 | doi-access = free }}</ref> Radiographically, hyperparathyroidism has a pathognomic finding of rugger jersey spine.<ref>{{cite web |url=https://radiopaedia.org/articles/rugger-jersey-spine-hyperparathyroidism-1 |title = Rugger jersey spine (hyperparathyroidism) {{!}} Radiology Reference Article {{!}} Radiopaedia.org| date=2 May 2008 }}</ref>  Parathyroid adenomas are very rarely detectable on clinical examination. Surgical removal of a parathyroid tumor eliminates the symptoms in most patients.{{citation needed|date=October 2021}}

In secondary hyperparathyroidism due to lack of vitamin D absorption, the parathyroid gland is behaving normally; clinical problems are due to bone resorption and manifest as bone syndromes such as [[rickets]], [[osteomalacia]], and [[renal osteodystrophy]].<ref>{{Cite web|title=Secondary Hyperparathyroidism: What is Secondary Hyperparathyroidism? Secondary Hyperparathyroidism Symptoms, Treatment, Diagnosis - UCLA|url=https://www.uclahealth.org/endocrine-center/secondary-hyperparathyroidism|access-date=2021-01-18|website=www.uclahealth.org}}</ref>