RT Journal Article SR Electronic T1 Primary hyperparathyroidism: 7,000 years of progress JF Cleveland Clinic Journal of Medicine JO Cleve Clin J Med FD Cleveland Clinic SP 1084 OP 1098 VO 72 IS 12 A1 Levine, Michael A. YR 2005 UL http://www.ccjm.org/content/72/12/1084.abstract AB Because of widespread screening of the serum calcium concentration, most patients with primary hyperparathyroidism now present with very mild disease instead of the severe bone or kidney manifestations seen in the past. The US National Institutes of Health (NIH) in their 2002 guidelines recommend surgery for patients with symptoms and for select patients without symptoms. But many now argue that all patients with primary hyperparathyroidism should be referred for surgery to reduce fracture risk and enhance general health.