Hyperparathyroidism

The parathyroid glands are pulling calcium out of bone and dumping it into the blood — and the symptoms mimic everything from kidney stones to psychiatric illness. Knowing the pattern saves the diagnosis.

Hyperparathyroidism means excess parathyroid hormone (PTH) is being secreted, most often from a benign adenoma on one of the four parathyroid glands (primary). PTH raises serum calcium by pulling it from bones, increasing renal reabsorption of calcium, and activating vitamin D to boost intestinal absorption. The result is hypercalcemia — serum calcium above 10.5 mg/dL — and the classic symptom cluster summarized as "bones, stones, abdominal groans, and psychic moans." Bones: pathologic fractures and bone pain from demineralization. Stones: renal calculi from excess calcium in urine. Groans: constipation, nausea, anorexia from slowed GI motility. Moans: fatigue, confusion, depression, lethargy. Nursing priorities center on hydration (3–4 L/day if cardiac status allows) to flush calcium through the kidneys, monitoring for cardiac dysrhythmias (shortened QT interval on ECG), preventing falls due to weakened bones, and straining urine for stones. Serum calcium, phosphorus (inverse relationship — phosphorus drops as calcium rises), and PTH levels guide monitoring. Severe hypercalcemia above 13 mg/dL is a medical emergency requiring IV normal saline and possible calcitonin administration.

Key Distinctions

Don't confuse hyperparathyroidism (high calcium, low phosphorus, high PTH) with hypoparathyroidism (low calcium, high phosphorus, low PTH) — they are mirror opposites. Students mix up hypercalcemia symptoms (constipation, lethargy, muscle weakness) with hypocalcemia symptoms (tetany, Chvostek's, Trousseau's). Remember: hypercalcemia sedates, hypocalcemia excites.

Clinical Pearl

"Bones, stones, abdominal groans, and psychic moans" — if you can recite the rhyme, you can spot hypercalcemia from hyperparathyroidism on any question stem.