The initial investigations such as parathormone (PTH), alkaline phosphatase (ALP), serum calcium and serum phosphate can point to the metabolic bone disease while 99mTechnetium- methylenediphosphonate (MDP) bone scan and 99m Technetium- sestamibi whole body scan are useful in differentiating and managing these conditions.[2,4] This case report aims to focus attention on the importance of considering brown tumors in the differential diagnosis of patients with ESRD and hyperparathyroidism, while also highlighting the diagnostic challenges and treatment outcomes associated with these lesions. Here, PTH is linked to hyperparathyroidism.