PTH and Hypercalcemia: The signs and symptoms of tertiary hyperparathyroidism are the same as primary hyperparathyroidism, bone pain, decreased bone mineral density, osteitis fibrosa cystica with pathological fractures, pruritus, muscular weakness, nephrolithiasis, anorexia, nausea, and weight loss, and they result from increased PTH levels and/or hypercalcemia [2].