Do I really need surgery if I'm 41 and was just diagnosed with adenoma w/ elevated pth?

Yes. In most cases, yes. Even if the calcium and PTH are mildly elevated now, there is a significant likelihood that they will get worse over time, and cause complications including osteoporosis, kidney stones, stomach ulcers, body aches, and high blood pressure that may improve, but not go away, after surgery. So unless someone is very frail or high risk, surgery is usually recommended.
Yes. Yes. Parathyroids regulate calcium (ca). When ca is high, parathyroid hormone (PTH) levels drop to help lower ca. When ca is low, increased PTH secretion help increase ca levels. Adenomas have lost their ability to regulate the secretion of PTH and therefor always secrete PTH prompting high ca levels. High ca leads to mental status changes, osteoporosis, and renal dysfunction to name a few.
Adenoma. Short answer is yes. Having an active adenoma can lead to significant problems with calcium metabolism. This can lead to bone disease, heart problems and more.
Yes. Surgery should be strongly considered. Otherwise you will suffer from severe osteoporosis in your retirement years.
Yes. Hyperparathyroidism can cause longterm problems if not treated. If you are healhy, surgery is indicated.
Yes. Pth = parathyroid hormone. It controls your calcium levels. An elevated PTH is most commonly seen when a parathyroid adenoma develops. The adenoma is making extra pth. Excess PTH causes your blood calcium levels to rise above the normal range. This will cause numerous side effects. Most of the time when the adenoma is removed surgically, the PTH and calcium will return to normal levels.