Some of the earliest, best-chronicled cases of primary hyperparathyroidism (PHPT) were patients who suffered from persistent or recurrent disease. One of the first operations was performed by Dr. Felix Mandl on Albert Ghane, a Viennese tram car conductor who presented with a femur fracture and advanced osteitis fibrosa cystica [1]. Mr Ghane was initially thought to be cured, but he developed a recurrence 6 years later and ultimately died of uncontrolled hypercalcemia. A similar early case was Captain Charles Martell, a U.S. merchant mariner who developed multiple bone fractures and recurrent kidney stones [2]. Captain Martell underwent six failed parathyroid explorations in the United States before a mediastinal adenoma was found during sternotomy by Drs. Edward Churchill and Oliver Cope.