Delayed diagnosis leading to severe complications in primary hyperparathyroidism caused by atypical parathyroid tumor

Severe skeletal complications at the onset of primary hyperparathyroidism are uncommon in contemporary Western clinical practice because routine serum calcium measurement usually allows early diagnosis. We describe a case of primary hyperparathyroidism in which delayed diagnosis, despite suggestive symptoms, led to an extremely severe presentation characterized by multiple fractures, osteolytic lesions, and prolonged postsurgical hungry bone syndrome requiring several months of intensive treatments and hospitalization. During hospitalization, the patient developed potentially life-threatening infectious and thrombotic complications. Management was further complicated by the diagnosis of an atypical parathyroid tumor, an uncommon and potentially aggressive cause of hyperparathyroidism.