Primary hyperparathyroidism is currently most often diagnosed after noting elevated serum calcium on routine testing. Most of these patients have a single parathyroid gland adenoma. Surgery can normalize biochemical parameters in 95% of patients, but a patient-oriented evidence approach must focus on patient-oriented outcomes rather than surrogate markers such as calcium level, PTH level, or bone density. Some complications, such as nephrolithiasis, are more clearly associated with primary hyperparathyroidism than others, but only a minority manifests such overt complications. Although there are some clear indications for surgery (such as nephrolithiasis), other indications are more relative and management should be individualized.
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