Hypercalcemia due to primary hyperparathyroidism (pHPT) is increasingly diagnosed and managed by surgical treatment. Majority of patients (90-95%) has a solitary adenoma and  preoperative technetium sestamibi scanning combined with cervical ultrasonography is highly accurate in locating the adenoma. Minimally invasive focused parathyroidectomy with intraoperative parathyroid hormone assay can be performed while conventional cervical exploration is reserved for minority of patients with negative localization or 4-gland hyperplasia. Surgical treatment requires overnight stay and recovery is expected within few days.

Surgery for secondary and tertiary hyperparathyroidism (HPT) is performed for patients with renal failure who develop biochemical, radiological features or symptomatology related to hyperparathyroidism. Total parathyroidectomy, with immediate autotransplantation of the parathyroid gland to the forearm, is performed as the procedure of choice.