The signs and symptoms of primary hyperparathyroidism are those of hypercalcemia. One cause of hypercalcemia is a condition known as hyperparathyroidism. Both processes lead to hypocalcemia and hence secondary hyperparathyroidism. Signs and symptoms include ectopic calcification, secondary hyperparathyroidism, and renal osteodystrophy. No evidence of metabolic disorders like hyperparathyroidism or hyperthyroidism was found in the specimens, either. Parathyroid carcinoma is sometimes diagnosed during surgery for primary hyperparathyroidism. Its germline mutation may also be responsible for the development of hyperparathyroidism and pheochromocytoma. Multiple endocrine neoplasia is more likely to be associated with childhood and adolescent primary hyperparathyroidism. It may also occur in the setting of hyperparathyroidism, hypothyroidism, and Cushing syndrome. Chronic kidney failure is the most common cause of secondary hyperparathyroidism. Alkaline phosphatase levels are usually elevated in hyperparathyroidism. Pediatric patients with primary hyperparathyroidism are best remedied by parathyroidectomy. Histologically similar to brown tumour found in hyperparathyroidism. Approximately 1 in 10 documented cases of hyperparathyroidism are a result of hereditary factors. Most cases are due to primary hyperparathyroidism or cancer.