Aim of the work: To evaluate the usefulness of the combination of sestamibi scintigraphy (SS) and neck ultrasonography (US) in patients with primary hyperparathyroidism (pHPT) undergoing parathyroidectomy. Patient and methods: Seventeen patients with proved pHPT were studied, excluding patients with persistent or recurrent disease. All patients underwent both SS and US prior to surgery, and   the   results  were    compared  with    operative  and   histological  findings. Results: Fourteen patients had single adenoma, 2 patients had hyperplasia and a single patient had multiple adenomas. US detected and localized accurately 10 cases, SS detected and localized the diseased parathyroid gland in 14 cases, while with combination we detected and localized the diseased parathyroid glands in 16 patients . Conclusions:When the preoperative localization of the PT glands is chosen, the combination ofSS  and US represents a reliable noninvasive localization technique and should be considered for use in a complementary way beginning with US and  if US couldn't localize the diseased gland SS will be the next step.