Do you recommend obtaining both a parathyroid ultrasound and a parathyroid nuclear medicine scan when evaluating a patient with recurrent calcium based nephrolithiasis who is found to have an elevated PTH level, hypercalcemia, and hypercalciuria?  

Yes. The scenario you describe is typical for primary hyperparathyroidism. Appropriate treatment includes removing the parathyroid adenoma. However, finding a parathyroid adenoma can be difficult. An enlarged one may be no more than a few millimeters in diameter. Our radiology staff recommends both ...

I agree, usually start with an US and then a PTG scan and if still questionable would proceed with a 4D CT scan. Sometimes it takes a while to identify it and I have had several pts that it has taken a few years with repeat scans. Unless the Calcium is very elevated, I would advise against explorato...