Primary hyperparathyroidism presenting as intractable nausea and vomiting.

Primary hyperparathyroidism (PHPT) is characterized by inappropriate secretion of parathyroid hormone (PTH). The proportion of PHPT with asymptomatic or nontypical symptoms is continuously increasing. PHPT typically affects elderly women, and it is characterized by few symptoms or complications. We explored a case of a 77-year-old woman with previously undiagnosed PHPT who presented first with palpitation and chest distress, and then had the symptoms of intractable nausea and vomiting. The initial laboratory investigations revealed normal calcium levels. Further examination showed serum calcium and PTH were elevated. In order to attach importance to PHPT in asymptomatic patients or patients with nontypical symptoms, related literature was reviewed. Finally the methods of treatment of PHPT in elderly patients were discussed.