Which of the following symptoms is NOT seen in someone who has hyperparathyroidism?

A. The elevated hemoglobin: Mr. Brown’s hemoglobin is not elevated; it is significantly below the normal range. Elevated hemoglobin would suggest polycythemia, which is not consistent with his symptoms of fatigue and poor nutrition.

B. The abnormal WBC count: His white blood cell count is within normal limits (9 x 10⁹/L), indicating no evidence of infection or leukemia. WBC count does not contribute to the diagnosis of his fatigue or anemia.

C. The abnormal platelet count: Platelets are within the normal range (300 x 10⁹/L). Normal platelet levels suggest that thrombocytopenia or clotting disorders are not the cause of his symptoms.

D. The abnormally low hemoglobin and hematocrit: Both hemoglobin (90 g/L) and hematocrit (.97 L/L) are well below normal, indicating anemia. This supports the diagnosis as a likely cause of his fatigue, particularly in the context of a poor diet lacking iron and other nutrients.

A. Fractures: Hyperparathyroidism increases parathyroid hormone (PTH) levels, which stimulates bone resorption. This weakens bones over time, making fractures a common complication. Fractures are a direct consequence of the excessive mobilization of calcium from bone.

B. Constipation: Elevated calcium levels in hyperparathyroidism can slow gastrointestinal motility, leading to constipation. This is a frequent symptom and is related to hypercalcemia affecting smooth muscle function.

C. Tetany: This symptom is characterized by involuntary muscle spasms and hyperreflexia, which are classic signs of hypocalcemia (low calcium) rather than hypercalcemia. Since hyperparathyroidism causes calcium levels to rise significantly, the neuromuscular system becomes depressed rather than hyper-excitable.

D. Kidney stones: Hypercalcemia from increased PTH promotes calcium crystallization in the kidneys, resulting in kidney stones. This is a common renal manifestation of hyperparathyroidism.

E. Nausea: High calcium levels can irritate the gastrointestinal tract and affect smooth muscle function, leading to nausea and sometimes vomiting. It is a frequent symptom associated with hypercalcemia.