Primary hyperparathyroidism is often asymptomatic; which finding may be seen as a presenting feature?

• A. Recurrent Nephrolithiasis
• B. Fever
• C. Leukocytosis
• D. Anemia

Answer: (A)

When parathyroid hormone is elevated in primary hyperparathyroidism, calcium rises in the blood and urine. The resulting hypercalciuria promotes formation of calcium-containing kidney stones, so stones can be an early presenting feature even if other symptoms are absent. Fever, leukocytosis, and anemia aren’t typical manifestations of PHPT; they point to infection or other conditions and don’t reflect the calcium-handling and bone effects driven by excess PTH.