A week ago on a Monday morning, a medical student in our internship came to my office accompanied by a classmate who wanted me to perform an ultrasound examination of her ureteral calculi in person. After a brief, seemingly simple interview, a familiar name quickly came to mind: parathyroid adenoma (PA). After confirming that she had ureteral calculi and diffuse mild calcification of the renal parenchyma, I immediately examined her parathyroid ultrasound, which revealed an approximately 2-cm tumor in her right inferior parathyroid area, which was very consistent with a parathyroid adenoma. Not only that, a solid mass of 1.5 cm in size was also found at the mid-superior junction of her right thyroid. From its shape and internal structural echo, it was highly suspected to be a relatively rare type of thyroid cancer, namely medullary thyroid carcinoma (MTC). At this point I looked at the clock on the ultrasound machine and it took less than 5 minutes. However, an inexplicable force drove me to take a closer look at her adrenal gland, and I found a solid nodule of only about 8 mm in size in the medial limb and crest of the right adrenal gland, which, although tiny, was very consistent with a pheochromocytoma. So, I quickly made an ultrasound diagnosis: multiple endocrine tumors type 2a (including three types of endocrine tumors 1, medullary thyroid carcinoma 2, parathyroid adenoma 3, pheochromocytoma). She was advised to measure serum calcitonin, parathyroid hormone, and catecholamines. At this point, the clock showed that the test took exactly 10 minutes. A week later the corresponding laboratory tests and MRI results proved the diagnosis of the three endocrine tumors mentioned above to be completely correct. Most parathyroid adenomas are sporadic, with about 15% occurring in patients with multiple endocrine tumors. As the name implies, multiple endocrine neoplasms are functional tumors of multiple endocrine glands, abbreviated as MEN, which at first glance appears to be a plural form of “men”, but are actually more common in women. The endocrine glands involved in MEN are the thyroid, parathyroid, pancreas, adrenal glands, and the neuroendocrine units of the mucosal tissue. The corresponding tumors are medullary thyroid carcinoma, parathyroid adenoma, islet cell tumor, pheochromocytoma, and neuroendocrine tumor, respectively. Both types involve parathyroid adenomas, as in this case, which involves medullary thyroid carcinoma, parathyroid adenoma, and adrenal pheochromocytoma, which is called type 2a, or Sipple syndrome. In this case, the first symptom was renal colic, and an emergency ultrasound revealed ureteral calculi. When I first saw the patient I noticed that she was very young, how could she have such severe kidney stones? Are there other underlying causes? Among the causes of kidney stones, primary hyperparathyroidism (PHPT) due to parathyroid adenoma is the first one to be considered, because this disease is so insidious that it has fooled the eyes of countless doctors. The kidney was lost due to serious kidney stones and hydronephrosis, and only years later was it found to be caused by parathyroid adenoma! It is really sad and regrettable. Ultrasound is very easy to use, as long as the sonographer’s mind is thinking about where to look, the ultrasound probe can quickly scan there. This convenience is unmatched by any other imaging test. I found a parathyroid adenoma along with a thyroid tumor that was highly suspicious for medullary carcinoma, and my mind quickly and involuntarily cut to the process of examining multiple endocrine tumors. The ultrasound probe returned to the abdomen from the neck and found a relatively small pheochromocytoma in the right adrenal region. From ureteral stones, to parathyroid adenoma, to medullary thyroid carcinoma, and finally to adrenal pheochromocytoma, the process took only 10 minutes, which is very fast. If CT or MRI or nuclear examinations were used, such a process would take at least 1 week. On the surface, it seems that the convenience of ultrasound examination has brought the patient a speedy and correct diagnosis, but in fact, the key is the ultrasonographer’s strong accumulation and flexible use of relevant basic knowledge and clinical expertise. Knowledge + curiosity + thinking is the quality element of quality diagnosis!