Abstract: A case of triple hyperparathyroidism with giant parathyroid adenoma showed by ⁹⁹Tc^m-MIBI SPECT/CT imaging was reported. The characteristics of the disease were analyzed from clinical symptoms, laboratory examinations, and imaging tests. Triple hyperparathyroidism(HPT), which is common in dialysis patients with chronic renal insufficiency, was deeply analyzed through literature review. The parathyroid glands are stimulated by hypocalcemia for a long time, and some tissues proliferate and turn into adenomas with autocrine function. The incidence of triple HPT is low, and the effect of medical treatment is poor. Timely ⁹⁹Tc^m-MIBI SPECT/CT imaging can be further qualitative and localized to facilitate the selection of appropriate treatment options.