Primary hyperparathyroidism is increasingly being diagnosed subsequent to the detection of hypercalcaemia using multichannel auto-analyser screening. This paper provides a local picture of the clinical presentation and management of primary hyperparathyroidism. A retrospective review was conducted of 44 patients with primary hyperparathyroidism who were treated at the Queen Elizabeth Hospital between January 1987 and July 1996. Twenty-five (56.8%) of the patients were asymptomatic. Only three (6.8%) patients gave radiograms that had features indicating primary hyperparathyroidism; seven (15.9%) had renal stones. The patients underwent one or more of the following localisation procedures: computerised tomography, ultrasonography, thallium-technetium subtraction scanning, and technetium Tc 99m sestamibi scanning. The latter method was the most sensitive (64.3%). Ten adenomas that could not be localised by any of these procedures were successfully removed during surgery. Surgery was successful in 94.4% of cases and surgical outcome was comparable to that reported in the literature.