Primary hyperparathyroidism affects women more than men, is more frequent in individuals older than 50 years, and is unusual in children. Postmenopausal women between the ages of 35 and 65 and elderly women are especially at risk. Regular screening of calcium levels as part of an annual physical examination is very important for all people older than 50. There are no known racial and ethnic considerations.
HISTORY. Many patients are asymptomatic. Early symptoms are polyuria (large amounts of urine), anorexia, and constipation, as well as weakness, fatigue, drowsiness, and lethargy. As the hypercalcemia increases, abdominal pain (from peptic ulcer disease), nausea, and vomiting are typical. The patient may report generalized bone pain and may have had recent fractures from what appeared to be little cause.
PHYSICAL EXAMINATION. Little definitive data can be obtained in a physical examination. Hypertension is common, and if the patient is on digitalis, there may be a significantly lowered pulse rate, which signals increased sensitivity to the drug. Muscle atrophy and depressed tendon reflexes are late signs of hypercalcemia. The patient may have marked muscle weakness and atrophy (particularly in the legs) and skeletal deformities. If the central nervous system is affected, there will be changes in mental status, such as confusion, disorientation, and even coma. Palpation of even grossly enlarged parathyroid glands is generally impossible because of their location.
PSYCHOSOCIAL. The hypercalcemic patient or the significant others may note memory changes, confusion, irritability, and symptoms of depression or paranoia (or both). The psychological clinical manifestations may range from mild to acute psychosis, or possibly paranoid hallucinations. The patient and significant others may be understandably upset or anxious about the changes in the patient's behavior.
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