The clinical profile of primary hyperparathyroidism (PHPT) has changed considerably, especially since the introduction of autoanalyzers in the laboratory, allowing calcium to be determined more frequently and a large number of cases of hypercalcemia to be detected. The most frequent causes are PHPT and cancer-related hypercalcemia. All of these factors have modified the prevalence of the clinical manifestations and currently the presence of recurrent kidney stones is observed in 20% of patients, while bone lesions, even the most subtle, are infrequent. Differentiating and establishing the limits between symptomatic and asymptomatic PHPT is difficult and many asymptomatic cases will never show disease progression, such as severe hypercalcemia, bone disease, hypercalciuria and/or kidney stones. An important question is whether patients not showing the classical manifestations of PHPT will benefit from surgery. This question is all the more important since, among patients not surgically treated, many are lost to follow-up after 5 to 10 years and the cost of follow-up exceeds that of surgery. Those against intervention base their arguments on the lack of progression in many patients and the possibility of alternative treatments.