PTH and asthenia: She presented with asthenia and persistent hypercalcemia (serum calcium 11.8 mg/dL; reference range 8.1–10.4), low serum phosphate (1.8 mg/dL; reference range 2.5–4.7), elevated intact PTH (452 pg/mL; reference range 10–75), low 25-hydroxyvitamin D levels (7 ng/mL; reference range 25–80), and high serum alkaline phosphatase (117 U/L; reference range 30–106 U/L).