Clinical data: A 51-year-old woman was referred for evaluation of an elevated calcium and parathormone levels which were detected on evaluation of recurrent nephrolithiasis.

Palpation: no abnormality.

Laboratory tests: TSH 1.04 mIU/L, parathormone 201 pg/ml, serum calcium 3.01 mM/L, phosphorus 0.71 mM/L

Ultrasonography. The thyroid was echonormal. There were two hypoechoic lesions in the right lobe, one in the upper pole and another one just under the lower pole.

Aspiration cytology was performed from both lesions and resulted in benign, colloid goiter and in benign lesion corresponding to parathyroid adenoma, upper and lower lesion, respectively.

Additional tests: wash-out thyroglobulin resulted in 56 ng/mL, wash-out parathormone did in 709 pg/mL.

MIBI scintigraphy disclosed an enlarged right lower parathyroid.

Histopathology: parathyroid adenoma.