PTH and anemia: Anemia (mainly of normocytic normochromic type in PHPT) is found in long standing PHPT due to direct PTH inhibition on erythrocytes, increased peripheral calcium-mediated destruction of red cells, long-term high PTH-induced medullary fibrosis while anemia in chronic kidney disease, a part form indicating a long standing severe condition, correlates with lack of kidney-associated erythropoietin synthesis [7,26,109].