Summary Persistent primary hyperparathyroidism and recurrent pancreatitis after resection of a parathyroid adenoma A 58-year-old man was hospitalised for severe acute pancreatitis and severe hypercalcaemia (4.86 mmol/L) due to primary hyperparathyroidism. After standard therapy the patient’s condition improved and one adenoma (2.25 g) and one enlarged parathyroid gland (0.217 g) were enucleated. The remaining three parathyroid glands were surgically and histologically normal, and intraoperative parathormone levels decreased significantly. Postoperatively both parathormone and serum calcium rose again, suggesting an additional ectopic parathyroid adenoma. 99m Technetium-sestamibi scintigraphy and MRI repeatedly failed to identify an additional ectopic adenoma. With hypercalcaemia persisting, a second severe attack of pancreatitis occurred. The hypercalcaemia was therefore treated with the oral calcimimetic drug cinacalcet. Under this therapy normal calcium levels were restored and the patient recovered completely. 16 months later a further severe attack of pancreatitis occurred during a transient episode of hypercalcaemia. This is the first case report in which, despite therapy with cinacalcet, persistent primary hyperparathyroidism caused further severe attacks of pancreatitis after resection of a parathyroid adenoma.