Summary

• Diagnosis is confirmed biochemically with synchronous elevation of serum calcium and inappropriate elevation of PTH.
• Normal serum intact PTH in the setting of hypercalcaemia does not rule out disease.
• Depression, cognitive changes, change in sleep pattern, and myalgias are common subjective complaints. There may be a history of nephrolithiasis or low bone mineral density.
• Physical examination is usually normal, but examination of the neck is essential to look for a hard, dense mass, suggestive of parathyroid carcinoma.
• Parathyroidectomy is the only definitive cure. Monitoring is an option for patients who have mild hypercalcaemia without surgical indications such as younger age, lack of ensured follow-up, impaired renal function, or osteoporosis.
• Localisation studies are performed preoperatively to locate the abnormal tissue such that a directed, minimally invasive parathyroidectomy can be performed.
• Intraoperative assessment of serum intact PTH is a useful guide to confirm adequacy of resection.
• Complications of surgery are uncommon but include hypocalcaemia, injury to the recurrent laryngeal nerve, bleeding, and pneumothorax.