Worldwide, asymptomatic primary hyperparathyroidism is a common endocrine disorder. This guideline collects the latest advances in the diagnosis, clinical presentation and treatment of asymptomatic PHPT, and makes a series of revisions to the 2009 guidelines for the management of asymptomatic PHPT. The main updates are as follows: 1. A more thorough evaluation of the skeletal muscle and renal system in patients with asymptomatic PHPT is recommended. 2. Further evaluation to determine skeletal muscle and renal involvement in patients with asymptomatic PHPT as part of the basis for asymptomatic PHPT surgery. 3. More detailed guidelines are needed to monitor patients who are not suitable for surgical parathyroid treatment. This guideline also addresses asymptomatic PHPT in terms of diagnosis, medication, and surgical treatment, respectively. For the diagnosis of asymptomatic PHPT, this guideline provides the following recommendations: 1) determine the range of serum PTH reference values from healthy individuals with adequate vitamin D; 2) both second- and third-generation PTH assays are useful for the diagnosis of PHPT; 3) normocalcemic PHPT is a variant of hypercalcemic PHPT; 4) test serum 25hydroxyvitamin D concentrations in patients with PHPT. If the patient is combined with vitamin D deficiency, vitamin D supplementation should be given; 5. Genetic testing may be helpful in the differential diagnosis of familial hyperparathyroidism or hypercalcemia. This guideline suggests that patients who can reduce blood calcium concentrations and increase bone mineral density (BMD) with satisfactory outcomes with drug therapy alone may be considered for treatment with available medications. For calcium intake in patients with PHPT, it is recommended that all patients follow existing guidelines and that calcium intake restriction is not recommended for patients with PHPT who have not undergone surgical treatment. Patients with PHPT with low serum 25-hydroxyvitamin D levels should receive vitamin D supplementation to maintain serum 25-hydroxyvitamin D levels above 50 nmol/l, preferably up to 75 nmol/l. The use of cenacaser is recommended to control the symptoms of hypercalcemia in patients with PHPT. For most patients with PHPT, cenacaser reduces blood calcium concentrations to normal and has no significant effect on serum It has no significant effect on serum PTH. The most well-documented treatment is alendronate, which significantly improves lumbar spine BMD in PHPT patients with no significant effect on calcium levels. In addition, the guideline states that combinations of different drugs may be considered to lower blood calcium and improve BMD, but there is a lack of evidence on the effectiveness of combination therapy. The guideline states that all patients with PHPT who are eligible for surgery should be evaluated by an experienced endocrine surgeon for risks, benefits, and potential complications. For patients with PHPT who do not have an indication for surgery, but who also do not have contraindications to surgery, a consultation with an experienced endocrine surgeon or a multidisciplinary endocrine symposium involving surgeons can help address the issues. Although imaging is not necessary for the diagnosis of PHPT, it can help the surgeon to localize and thus optimize the surgical treatment plan. Surgical treatment can provide significant benefits to patients due to its high cure rate and low complication rate, in addition to evidence that surgical treatment can reverse skeletal abnormalities in patients with PHPT. Professor John P. Bilezikian of Columbia University, USA, a member of the 4th Asymptomatic PHPT Working Group, concluded, We believe that these guidelines can help endocrinologists and surgeons in the management of patients with asymptomatic PHPT. We also propose a plan for future research to conduct further studies to address those current issues that remain unclear or controversial.