A two-center observational study reported that fluorocholine PET/CT localized abnormal tissue in more than 75% of primary hyperparathyroidism patients with non-conclusive conventional scans. The imaging results also correlated with surgical intervention. The findings position fluorocholine PET/CT as a practical escalation tool when standard localization fails, potentially reducing uncertainty at the decision point for resection. For endocrine surgery and nuclear medicine, the study supports expanded evaluation of fluorocholine PET/CT pathways in routine workups, especially for patients with persistent or recurrent disease signals.