Problem: A 47 year old female was seen in her physician's office as a follow up visit. Results for lab tests ordered during previous visit revealed elevated calcium in the bloodstream. A second lab test found an excessive amount of parathyroid hormone in the bloodstream. Follow-up imaging studies confirmed the presence of a benign parathyroid adenoma. The patient is presently complaining of muscle weakness, fatigue and some nausea and intermittent vomiting. Base on these findings, the physician concludes that the patient is demonstrating primary hyperparathyroidism. The physician explains to the patient that the hyperparathyroidism can only be cured by surgical excision of the parathyroid adenoma. The patient refuses surgery. The physician agrees the need for surgery is not urgent at this time and orders a bone density radiologic test to be done next week. The patient will have a follow up appointment in one month and measurement of calcium levels and renal functions in six months. Symptoms of the primary hyperparathyroidism were treated at this time.