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

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.