Introduction:Primary hyperparathyroidism (PHPT) is largely a symptomatic disease with varied systemic manifestations, complicated by coexisting Vitamin D (Vit D) deficiency. Increasing awareness, developments in diagnostics, and Vit D supplementation may have an impact on the disease profile of PHPT.Methods:Clinical, biochemical, and pathological profile of PHPT presenting to a tertiary care center in South India were compared in two groups separated as per the period of presentation (Group A: January 1994–May 2007 - 51 cases and Group B: June 2007–January 2015 - 59 cases).Results:PHPT has remained a disease of female preponderance with similar age of presentation. It is being diagnosed earlier (mean duration of symptoms prior to diagnosis was 38.7 months in Group A, significantly longer than 26 months in Group B). Bone pain and metabolic myopathy were the most common presentations (60%) followed by pathological fracture (16%), renal calculi (13%), and pancreatitis (7%). Pathological fractures have become less frequent. Vit D deficiency is still a widespread co-morbidity. Radionuclide scintigraphy is an effective localizing tool, but ultrasound can be an inexpensive and widely available screening modality.Conclusion:PHPT still remains asymptomatic disease of bones and stones, although it is being diagnosed early. Greater awareness, Vit D supplementation, and better diagnostic tools have made it a disease with lesser morbidity and effective cure.

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BACKGROUNDOvarian pregnancy is a rare condition and high index of suspicion is needed. Ovarian pregnancy comprises 0.15% of all pregnancies and 1-3% of ectopic gestations. 1 Clinical diagnosis can be diffi cult and challenging. If an ovarian pregnancy ruptures, mortality is quite high.In this case of right ovarian pregnancy, the clinical fi ndings were mild and not characteristic of an ectopic pregnancy. She attended accident and emergency earlier on in the day and was discharged. This case illustrates how an ovarian pregnancy can be easily missed and the patient can even be discharged. CASE PRESENTATIONA 25-year-old female at 10 weeks gestation (spontaneous conception) in her fourth pregnancy presented to accident and emergency department with vaginal bleeding and lower abdominal discomfort. There was no history of dizzy spells or faintness. There was no history of vomiting, bladder or bowel problems. She had used Implanon as

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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.