Symptoms include lethargy, fatigue, depression, memory loss, psychosis, ataxia, delirium, and coma.Left ventricular hypertrophy may also be seen.Other signs include proximal muscle weakness, itching, and band keratopathy of the eyes.When subjected to formal research, symptoms of depression, pain, and gastric dysfunction seem to correlate with mild cases of hypercalcemia. Causes
The most common cause of primary hyperparathyroidism is a sporadic, single parathyroid adenoma resulting from a clonal mutation (~97%). Less common are parathyroid hyperplasia (~2.5%), parathyroid carcinoma (malignant tumor), and adenomas in more than one gland (together ~0.5%).Primary hyperparathyroidism is also a feature of several familial endocrine disorders:  Multiple endocrine neoplasia type 1 and type 2A (MEN type 1 and MEN type 2A), and familial hyperparathyroidism.Genetic associations include:

In all cases, the disease is idiopathic, but is thought to involve inactivation of tumor suppressor genes (Menin gene in MEN1), or involve gain of function mutations (RET proto-oncogene MEN 2a).Recently, it was demonstrated that liquidators of the Chernobyl power plant are faced with a substantial risk of primary hyperparathyroidism, possibly caused by radioactive strontium isotopes. Diagnosis
The diagnosis of primary hyperparathyroidism is made by blood tests.Serum calcium levels are usually elevated, and the parathyroid hormone level is abnormally high compared with an expected low level in response to the high calcium. A relatively elevated parathyroid hormone has been estimated to have a sensitivity of 60–80% and a specificity of approximately 90% for primary hyperparathyroidism.A more powerful variant of comparing the balance between calcium and parathyroid hormone is to perform a 3-hour calcium infusion.
Cefpodoxime is an oral, third-generation cephalosporin antibiotic. It is active against most Gram-positive and Gram-negative organisms. Notable exceptions include Pseudomonas aeruginosa, Enterococcus, and Bacteroides fragilis. Currently, it is only marketed as generic preparations in the US, according to the FDA Orange Book. It is commonly used to treat acute otitis media, pharyngitis, sinusitis, and gonorrhea. It also finds use as oral continuation therapy when intravenous cephalosporins (such as ceftriaxone) are no longer necessary for continued treatment. Cefpodoxime inhibits cell wall synthesis by inhibiting the final transpeptidation step of peptidoglycan synthesis in cell walls. It has well established pharmacokinetic profile with absorption of 50%. It is indicated in community acquired pneumonia, uncomplicated skin and skin structure infections, and uncomplicated urinary tract infections. It was patented in 1980 and approved for medical use in 1989. Spectrum of bacterial susceptibility and resistance
Cefpodoxime has been used to fight pathogenic bacteria responsible for causing gonorrhoea, tonsillitis, pneumonia, and bronchitis. Representative pathogenic genera include Streptococcus, Haemophilus, and Neisseria. The following represents MIC susceptibility data for a few medically significant microorganisms. Haemophilus influenzae: ≤0.03 – 1 μg/ml
Neisseria gonorrhoeae: 0.004 – 0.06 μg/ml
Streptococcus pyogenes: ≤0.004 – 2 μg/ml

Brand name
Zoetis markets cefpodoxime proxetil under the trade name  Simplicef for veterinary use, Finecure, India markets the products under trade name Cefpo.Vantin (by Pfizer) in suspension or tablet form.