Background: Parathyroid cysts are a rare etiology that represent less than 1% of parathyroid pathology. They are often classified as functional or non-functional and can present as asymptomatic incidental findings or in some cases causing airway compression or severe hypercalcemia. Methods: We present two cases of new onset primary hyperparathyroidism with concurrent cystic lesions of the anterior neck. In both cases, preoperative SPECT-CT scans were equivocal for the presence of parathyroid adenomas. Surgical resection of the lesions resulted in intraoperative decrease of PTH to normal levels. Results: Both patients experienced resolution of any symptoms and normalization of calcium levels. Pathology confirmed the diagnosis of cystic parathyroid adenoma, not suspicious for malignancy. Conclusion: While extremely rare, functional parathyroid cyst should be considered in the evaluation of a patients with hypercalcemia and a cystic central neck mass.