Introduction: In Primary Hyperparathyroidism (PHPT) surgery, up to 5% of patients may present persistence or recurrence of their disease. The causes of each of these situations depend on multiple factors related to the disease itself, preoperative location, the type of surgery chosen and performed, intraoperative examinations and the surgeon’s experience. Methods: We present 14 cases of persistence and recurrence with different aspects. Results: Description of clinical cases. Conclusion: Literature review and description of confrontation diagram to guide the study, possible causes and therapeutic management.