<prompt> Increased Ca, decreased P04.Diagnosi-Primary hyperparathyroidismSecondary hyperparathyroidism due to Vit D deficiencyMalignancyOsteoporosis  <response>: Lab Diagnosis of primary hyperparathyroidismFigs 9.18 to 9.21 a.Biochemical 1.Simultaneous parathormone and calcium level should be taken 2.Parathormone level is increased 3.Increased calcium more than 12 mg, and chloride 4.Decreased phosphorus, potassium and bicarbonate 5.Serum chloridephosphorus ratio is diagnostic more than 75 normal 32 b.Urinary calcium excretion is increased c.ECG--Sho QT interval d.Localisation by USG, CT, MRI, nuclear thallium technetium scan and parathyroid angiography Figs 9.20 and 9.21.e.Radiological findings in hyperparathyroidism include osteitis fibrosa cystica, subperiosteal erosion especially along the radial aspect of middle phalanx, pepper pot skull Fig. 9.19. R ALAGAPPAN MANUAL OF PRACTICAL MEDICINE FOUH EDITION PAGE NO-630 