PTH and parathyroid gland adenoma: Typically, the diagnosis of severe hyperparathyroidism-along with the identification of a parathyroid adenoma-arises during the evaluation of severe osteoporosis rather than as a result of symptomatic hypercalcemia [4]. In this particular case, however, we observe a rare juxtaposition: the presence of severe osteoporosis and parathyroid adenoma coexists with normal serum calcium, parathyroid hormone, and vitamin D levels.