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Parathyroid adenoma is an uncommon disease in Korea. However, the frequency of this disease has slowly increased with routine measurement of serum calcium and increasing awarenes by the public of hyperparathyroidism in recent years. We have experi-me of surgical treatment retrospectively. Four cases were diagnosed by persistent elevation of serum calcium and parathyroid hormone. They presented asymptomic clinical symptoms, osteoporosis/ osteodeficiency, or renal stone, gastrointestinal disturbance or neck mass. Parathyroid lesions were detected preoperatively by ultrasonography, thyroid scanning or neck computerized tomographic imaging in three of them. The tumor locations were left lower in two cases and right lower in two cases. Al patients received guideline for beter diagnostic strategies, proper surgical management and follow-up study for recurence in the primary hyperpa-rathyroidism. (Korean J Otolaryngol 2003 ;46 :890-5)