Primary hyperparathyroidism is commonly caused by parathyroid adenoma which leads to production of excessive PTH[4] whereas, secondary hyperparathyroidism is a compensatory mechanism in chronic calcium-wasting conditions like chronic kidney disease (CKD).[3] In rare instances, these novel tumors occur in presence of tertiary hyperparathyroidism as described by Topal. This evidence concerns the gene PTH and parathyroid gland adenoma.