Although surgery is unambiguously recommended for symptomatic primary hyperparathyroidism (PHPT) patients, management options for asymptomatic patients have varied between surgery, medications and follow-up. To deal with this issue, four International Workshops have taken place, in 1990, 2002, 2008 and 2014, during which a team of experts drew up criteria to stratify asymptomatic patients as surgery-eligible and surgery-ineligible. The efficacy of the criteria have however been questioned over the years and the majority of patients, both eligible and ineligible, may eventually have undergone surgery. Nevertheless, the criteria are still in use today and they clearly mirror the course of change in the treatment of PHPT patients.