In primary hyperparathyroidism about 75% of people have no symptoms.[1] The problem is often picked up during blood work for other reasons via a raised calcium.[3] Many other people only have non-specific symptoms. Symptoms directly due to hypercalcemia are relatively rare, being more common in patients with malignant hypercalcemia. If present, common manifestations of hypercalcemia include weakness and fatigue, depression, bone pain, muscle soreness (myalgias), decreased appetite, feelings of nausea and vomiting, constipation, polyuria, polydipsia, cognitive impairment, kidney stones (See Foot Note[nb 1]) and osteoporosis.[9] A history of acquired racquet nails (brachyonychia) may be indicative of bone resorption.[10] Parathyroid adenomas are very rarely detectable on clinical examination.