The symptoms and physical findings consistent with hyperparathyroidism are illustrated in Figure 5-4. The physical examination is aimed at determining the etiology of hypercalcemia once the diagnosis is confirmed by the laboratory. In chronic, slowly progressive hypercalcemia, serious symptoms are usually absent or mild until the calcium level is very high (> 13.0 mg/dL).9 Symptoms and clinical manifestations in patients with PHPT do not correlate with blood calcium results, except in patients with profound hypercalcemia in which nausea, vomiting, pancreatitis, and coma are very common.

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