Primary hyperparathyroidism (PHPT) arises from an unregulated overproduction of PTH from an abnormal parathyroid gland. The majority of patients who have an elevated serum calcium level have a problem in one or more of their parathyroid glands. The only definitive and curative treatment of PHPT is an operation. More than 95% of patients with PHPT are symptomatic and only the minority is truly asymptomatic. Criteria exists for the management of the asymptomatic patient but the trend is shifting towards the surgical management of all patients with this disease independent of symptoms who have a reasonable life expectancy and suitable operative and anesthesia risk. This review paper will focus on the current thinking PHTP which is one of the most common endocrine disorders seen today.