Gómez-Ramírez J, et al. - Researchers sought to compare the clinical presentation between normocalcaemic and hypercalcaemic forms of primary hyperparathyroidism using ionized calcium levels as an inclusion criterion. they divided 104 patients who were referred for surgery for primary hyperparathyroidism (PHPT) into 2 groups (hypercalcaemic (hPHTP)/normocalcaemic (nPHPT)). As per observations, patients with nPHPT most appear to be an attenuated form of the classical presentation. High ionized calcium levels were identified in 64% of the patients who were initially classified as normocalcaemic. A higher incidence of multiglandular disease and small adenomas was observed. The imaging tests exhibited a lower sensitivity. The improvement in diagnostic sensitivity supports employing ionized calcium levels in patients assumed to have nPHPT.