Primary hyperparathyroidism (pHPT) classically presents as hypercalcemia with elevated serum intact parathyroid hormone (iPTH) as a result of the hyperfunction of one or more parathyroid glands. These biochemical characteristics are not criteria for the diagnosis of pHPT as variants of the disease exist. Currently, patients most commonly present with asymptomatic hypercalcemia due to the increase in routine laboratory testing with less than 20% of patients presenting with overt symptoms [1]. Patients may have an elevated PTH, classic pHPT, or nonsuppressed PTH levels, normohormonal pHPT (NHpHPT), in the setting of hypercalcemia. Another clinical variant of pHPT is normocalcemic pHPT (NCpHPT) defined as normal calcium levels with an elevated intact PTH [2]. As relatively new clinical variants, evidence-based guidelines for the management of NHpHPT and NCpHPT are not well established (Table 4.1).