We describe a rare case of 32-year-old male with multiple endocrine neoplasia type 1 (MEN1) gene mutation characterised by extensive parathyroid hyperplasia and pancreatic neuroendocrine tumour. Pre-operative Tc-99m Sestamibi scan showed multiple hyperfunctioning parathyroids which were confirmed intraoperatively to be giant hyperplastic glands and an ectopia in the mediastinum. According to the current guidelines, pre-operative imaging is of limited benefit in MEN1 parathyroid disease, nevertheless this case does demonstrate utility of preoperative Sestamibi scintigraphy in accurately estimating the extent of disease in MEN1. Consequently, it facilitates better surgical planning and decreases the chance of persistent disease.

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