Although there is no doubt that total parathyroidectomy constitutes the treatment of choice for symptomatic hypercalcaemic MEN1 patients [2], the decision for the timing for the parathyroid surgery should take under account the severity of the PHPT symptoms, the circulating PTH and calcium levels, the presence of MEN1-associated endocrinopathies, especially the Zollinger-Ellison syndrome (ZES) and the patient's age [26]. Here, PTH is linked to multiple endocrine neoplasia type 1.