Typical parathyroid-related symptoms involving skeletal, renal or gastrointestinal systems

Markedly elevated serum calcium level (1 to 1.6 mg per dL [0.25 to 0.40 mmol per L] above accepted normal range)

History of an episode of life-threatening hypercalcemia

Reduced creatinine clearance (30% less than that expected)

Presence of kidney stones on radiograph

Markedly elevated urinary calcium excretion (greater than 400 mg per 24 hours [10 mmol per day])

Substantially reduced bone mass as determined by direct measurement (>2 standard deviations below that expected)

Significant neuromuscular or psychologic symptoms without other obvious cause

Patient requests surgery

Consistent follow-up is unlikely

Coexistent illness complicates management

Patient is young (<50 years of age)