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Patients with symptomatic PHPT as well as asymptomatic patients who meet any one of the guideline criteria should be advised to undergo parathyroidectomy [4, 24]. Table 3 shows the indication of surgery in PHPT. Surgical consultation can be offered to those who do not meet guidelines for surgery.

Genetic testing is advised for patients suspected of having a genetic disorder, such as young patients (<30 years of age), patients with syndromic findings and/or a positive family history of syndromic PHPT, and patients with multiglandular disease, such as parathyroid carcinoma [4]. The surgical approach for patients with a genetic etiology may differ from those with a sporadic parathyroid adenoma, in that multiglandular disease is more common when there is a genetic etiology. Preoperative localization studies are recommended with ultrasound, ^99mTc-sestamibi nuclear scintigraphy, CT, MRI, or PET scans. The choice of preoperative imaging depends on the experience of the surgical center.