A unique ca(u)se of quadriparesis.

Primary hyperparathyroidism (PHPT) is an uncommon cause of neuromuscular weakness which is often ignored due to non-specific nature of complaints. The authors present a case of PHPT with severe 25-hydroxyvitamin D (25(OH)D) deficiency which presented with quadriparesis. Normocalcaemic hyperparathyroidism with hypophosphatemia was documented initially and correction of 25(OH)D deficiency unmasked hypercalcaemia. A parathyroid adenoma causing PHPT was localised with radiology and scintigraphy of neck. An ectopic supernumerary parathyroid adenoma was identified and removed from the right tracheoesophageal groove during bilateral exploration of neck and the patient was completely cured after surgery.