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PHPT mainly affects women, with a female to male ratio of 3–4:1 [2, 3]. When the first several hundred individuals with PHPT were described in the 1930s at Massachusetts General Hospital, 57% had kidney stones, 8% had peptic ulcer disease, and 23% had bone complications [4]. Over the past 5 decades, the clinical presentation of PHPT has changed in several regions of the world. The clinical evolution of PHPT from symptomatic to asymptomatic has occurred primarily in the USA and Europe, although other countries have more recently appreciated this change as well. Similar to the epidemiology in North America, PHPT in Europe most often presents as an asymptomatic disorder. Both in Sweden and Denmark, the incidence of PHPT appears to be increasing, perhaps because of an increase in the use of screening methods [6, 15, 16].