Most patients with primary hyperparathyroidism are best treated by surgery. If the condition is due to a solitary adenoma, then this should be excised. If the condition is due to four-gland hyperplasia, then surgeons remove three-and-a-half parathyroid glands. In patients in whom surgery is contraindicated, medical therapy for hypercalcaemia may be necessary if the patient is symptomatic. In many patients who are asymptomatic, and whose serum calcium concentration is only marginally elevated, active therapy may not be indicated.
