Primary hyperparathyroidism is a condition caused by abnormal parathyroid glands producing an excessive amount of parathyroid hormone, resulting in consistently elevated total serum calcium levels. Primary hyperparathyroidism (pHPT) and familial hypocalciuric hypercalcemia (FHH) are both conditions characterized by high calcium levels, but their management and treatment approaches are completely different. pHPT typically requires surgical intervention, while FHH, a genetic condition, is typically managed conservatively because it is benign and does not lead to the complications seen in pHPT. This condition can be diagnosed based on clinical criteria and laboratory studies. Localization of the affected glands can be achieved with imaging studies mainly including ultrasound scan and technetium Tc 99m sestamibi. The most effective treatment for pHPT is parathyroidectomy.