Abstract
Background: Parathyroid adenomas are uncommon in patients with chronic kidney disease (CKD) undergoing haemodialysis, where secondary hyperparathyroidism typically presents as diffuse parathyroid hyperplasia. The occurrence of multiglandular parathyroid disease in this population is exceedingly rare and poses diagnostic challenges.
Case presentation: A 23-year-old male with end-stage renal disease on haemodialysis presented with biochemical evidence of hyperparathyroidism, characterized by markedly elevated parathyroid hormone levels, low to normal serum calcium, and elevated serum phosphate levels. Investigations: Neck ultrasonography identified two hypoechoic nodules inferior to both thyroid lobes. Dual-phase [⁹⁹ᵐTc] Tc-MIBI scintigraphy demonstrated focal tracer uptake in both regions on early and delayed images, consistent with bilateral parathyroid adenomas.
Diagnosis: Based on clinical, biochemical, and imaging findings, a diagnosis of bilateral parathyroid adenomas (multiglandular disease) was established in a dialysis-dependent CKD patient.
Discussion: Multiglandular parathyroid adenomas are exceptionally rare in young patients with CKD. The case emphasizes the diagnostic significance of advanced non-invasive imaging modalities, particularly Tc-MIBI scintigraphy, in differentiating adenomas from hyperplastic glands and localizing lesions accurately.
Conclusion: Recognition of atypical presentations of parathyroid adenomas in CKD patients is crucial to ensure timely and appropriate management, thereby preventing complications associated with persistent parathyroid hormone elevation and mineral metabolism disorders.

Key words: Chronic kidney disease, dual phase MIBI scintigraphy, haemodialysis, parathyroid adenoma, secondary hyperparathyroidism.