How is clinical presentation of PHPT?

Historically (long-standing disease, nephrolithiasis, brown tumors, osteitis fibrosa cystica, muscle atrophy) Now (seen much earlier by hypercalcemia, up to 80% dx subclinically, and very few were overt) Symptoms (non specific [fatigue, weakness, depression, bony pain, memory loss, decreased concentration] common manifestations [nephrolithiasis-20%, subtle change in bone densitometry -altered by high bone turn over results in osteopenia,porosis, various cardiovascular conditions- HTN, valvular calcification, LVH, mortality])