Hypercalcemia (stones, bones, groans, etc.) may be presented as a primary issue from a referring physician or may require you to complete the initial workup. Regardless, it will fall to you to ascertain the etiology of hypercalcemia and then decide on the type of hyperparathyroidism. While all types of hyperparathyroidism may be treated with surgery, the indication for surgery in secondary and tertiary hyperparathyroidism is not as firmly established as that for primary hyperparathyroidism. 1. primary hyperparathyroidism - about 80% adenoma; about 2% double adenoma 2. secondary hyperparathyroidism - hyperplasia often secondary to renal failure 3. tertiary hyperparathyroidism - autonomous functioning glands after etiology causing secondary hyperparathyroidism has been treated (most common in renal transplant patients) 4. quaternary hyperparathyroidism - adenoma formation after developing tertiary hyperparathyroidism.