PTH and hypercalcemia disease: The finding of a palpable neck mass accompanied by hypercalcemia, moderately elevated PTH values but resistant to calcimimetics or very high serum calcium (>13–14 mg/dL), and very high MIBI uptake or ultrasonographic features suggestive of malignancy (irregular margins, calcifications, thick capsule, and depth/width ratio > 1) in an ESRD patient in his 40s or 50s should raise concern and ideally be followed by alternative imaging techniques such as a CT scan.