It is the most common cause of hypercalcemia,1,2 with a prevalence of 0.1% to 1.0% and incidence of 28 cases per 100 000.3,4,5 A biochemical diagnosis is made in the setting of elevated calcium and nonsuppressed parathyroid hormone (PTH).1 Classic symptomatic PHP is associated with osteoporosis, fracture, and urolithiasis. Here, PTH is linked to urolithiasis.