A 47-year-old woman diagnosed with primary hyperparathyroidism (pHPT) presented for surgery consultation. She had an increased calcium of 10.6 mg/dL (2.65 mmol/L) on routine blood work, with an albumin concentration of 4.0 mg/dL. Follow-up testing performed on the same sample revealed an increased parathyroid hormone (PTH) concentration of 105 pg/mL. She also had an elevated 24-h urine calcium of 397 mg/day (9.9 mmol/day). Her main complaint was significant fatigue. She did not present with any neurocognitive or neuropsychiatric symptoms, bone pain, kidney stones, osteopenia, or osteoporosis. There was no evidence of chronic kidney disease (CKD). She also denied symptoms of neck compression, neck pain, dysphagia, and hoarseness. Her past medical history included obesity, hypertension (treated with triamterene-hydrochlorothiazide and amlodipine), endometriosis, and vitamin D insufficiency. Her family history was negative for parathyroid disease, and her social history was noncontributory. Her work-up for pHPT included an initial sestamibi scan, which did not show a parathyroid adenoma.