# Primary hyperparathyroidism presenting with pathological fractures mimicking malignancy: a case from Tanzania

## TL;DR

A woman in Tanzania with severe bone disease due to undiagnosed primary hyperparathyroidism was initially suspected of having cancer.

## Contribution

This case highlights the importance of considering metabolic bone disease in resource-limited settings where routine screening is unavailable.

## Key findings

- The patient had severe hypercalcemia and elevated parathyroid hormone levels, consistent with primary hyperparathyroidism.
- Pathological fractures occurred after minor trauma, mimicking malignancy but confirmed to be due to metabolic bone disease.
- Parathyroidectomy led to functional recovery, though hungry bone syndrome required calcium and vitamin D supplementation.

## Abstract

Primary hyperparathyroidism (PHPT) is commonly detected incidentally in high-income settings, but in resource-limited contexts it may still present with advanced skeletal disease. We report a 45-year-old woman with a seven-year history of progressive bone pain culminating in pathological fractures of the femoral neck and proximal humerus after minor trauma. Malignancy and myeloma were excluded by histology and hematologic work-up. Biochemistry showed severe hypercalcemia with strikingly elevated parathyroid hormone and alkaline phosphatase; imaging demonstrated diffuse osteopenia and localized enlarged parathyroid glands. She underwent parathyroidectomy with subsequent hungry bone syndrome, managed with calcium and vitamin D supplementation, followed by functional recovery and planned orthopedic fixation. This case highlights the risk of misdiagnosis where routine biochemical screening is limited, and emphasizes early consideration of metabolic bone disease in patients with unexplained fractures once malignancy is excluded.