Findings from Riyadh confirmed previous observations in 2007 from the same region, highlighting osteoporosis as the most common skeletal manifestation [7] as well as the earlier study in 1999 having the same high prevalence of single PTH adenoma [6], with Riyadh being the only region having all the cases of lower left lobe adenomas in the present study. Here, PTH is linked to osteoporosis.