In a Clinical Crossroads article published in April 2006,1 Gordon J. Strewler, MD, discussed the epidemiology and pathophysiology of primary hyperparathyroidism, as well as the medical and surgical treatment options. The patient, Ms Q, had a history of hypercalcemia first noted on random testing in 2001. Her initial calcium level was 11.3 mg/dL, and her parathyroid hormone level was elevated at 94 pg/mL. A year later, at the time of the conference, her calcium level was 10.4 mg/dL, with albumin at 4.1 g/dL, phosphate at 3.4 mg/dL, and parathyroid hormone at 101 pg/mL. In 2000, her bone density was normal (T score, −0.88 spine and −0.09 total hip). Two years later, her bone density had decreased by 7.3% at the spine and 5.2% at the femoral neck. Based on these findings, Ms Q was believed to have mild primary hyperparathyroidism and was referred to a parathyroid surgeon for consideration of parathyroidectomy. Ms Q was feeling well and wondered both if there were alternatives to surgery and what factors would necessitate her having a surgical procedure.