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Medical options are limited for patients with asymptomatic hypercalcemia who are unable or unwilling to undergo a surgical procedure [38]. Patients not undergoing surgery should maintain adequate hydration and remain physically active. Use of thiazides and lithium should be avoided. Dietary calcium intake of 800–1,000 mg/day is advised to minimize bone loss and avoid aggravation of hypercalcemia or hypercalciuria. Dietary calcium intake of less than 600 mg/day may stimulate physiologic hyperparathyroidism. Oral or intravenous administration of phosphate should be avoided because of the risk of precipitation of ectopic calcification. Estrogen replacement therapy may help normalize serum calcium levels and prevent bone loss in postmenopausal women, although PTH and phosphate levels do not change [39]. Orally and intravenously administered bisphosphonates may be beneficial, but oral etidronate and intravenous clodronate and pamidronate infusions have not shown any long-term benefit. Alendronate, risedronate, raloxifene, and salmon calcitonin administered by nasal spray or injection have not been extensively investigated for this indication, although reports indicate that alendronate [40] or raloxifene [41] may help decrease serum calcium levels. The CaSR agonist (calcimimetic) cinacalcet HCl has been shown to decrease serum calcium and maintain normal levels of serum calcium for as long as 5 years without changing bone mineral density [42], and to improve serum calcium levels in patients with intractable PHPT or parathyroid carcinoma. Asymptomatic patients with PHPT who do not have parathyroidectomy tend to do well, although as many as a quarter of these patients may develop progression of disease, defined as development of at least one new indication for surgery, over 15 years of follow-up, and younger patients less than 50 years old tend to have a higher incidence of progressive disease.