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Primary hyperparathyroidism often presents with protean manifestations, resulting in delayed diagnosis. At times, aberrant development and migration of the gland leads to ectopic location leading to problems in localization. Judicious use of combination methods of localization is recommended in treatment failure or recurrent disease. We report the use of single photon emission computed tomography-CT in precise localization of parathyroid adenoma in a patient with failed initial surgery.