The natural distribution of causation for primary hyperparathyroidism is roughly 85% solitary adenomas, 10-15% diffuse hyperplasia, and 1% cancer.

SPECT (three-dimensional) imaging, as an adjunct to planar methods, may increase sensitivity and accuracy,[2] especially in cases of small parathymic adenomas.

In patients with nodular goiter or functional tumors of the thyroid gland, increased uptake of the sestamibi agent is possible and makes parathyroid localization difficult or confusing.

[citation needed] Newer modalities using the same sestamibi tracer in more sophisticated scanners, such as SPECT/CT machines, have improved localization of parathyroid adenomas, especially in ectopic locations.

This operation is now termed a "minimally invasive parathyroidectomy", sometimes using a radionuclear detection probe, and correlated with intra-operative parathyroid hormone level measurements.