The diagnosis of normocalcemic hyperparathyroidism is made based on biochemical analysis and is characterized by consistently elevated parathyroid hormone levels with normal serum calcium levels. It is important to distinguish this clinical entity from secondary causes of parathyroid hormone elevation. Patients with this condition are often identified during evaluation of osteoporosis or nephrolithiasis and compared to patients with classic primary hyperparathyroidism are more likely to have multigland disease identified at the time of surgery. Surgery may involve targeted parathyroidectomy or bilateral exploration with removal of multiple parathyroid glands. The goal of surgery is normal calcium and parathyroid hormone levels at 6 months postoperatively with improved bone mineral density.