Many experts recommend surgery in the following circumstances (1): Serum calcium 1 mg / dL (0.25 mmol / L) greater than the upper limits of normal Hypercalciuria (> 250 mg / day [> 6.25 mmol / day] in women or > 300 mg / day [>7.5 mmol / day] in men) or the presence of nephrolithiasis Creatinine clearance < 60 mL / minute (< 1 mL / second) Vertebral bone fracture or bone density at the hip, lumbar spine, or radius that is 2.5 standard deviations below controls (T score = −2.5) Age < 50 years The possibility of poor adherence with follow-up Surgery consists of removal of adenomatous gland (s).