Multiple fractures in primary hyperparathyroidism: a challenging case report

<b>Background</b>: Primary hyperparathyroidism due to overproduction of parathyroid hormone may present with fatigue, renal stone, abdominal pain, constipation; However, it is rare to observe a pathological fracture as the initial manifestation. We present a case of a young woman with multiple fractures, highlighting the diagnostic challenge. <b>Case presentation</b>: A 35-year-old woman was presented with pain, swelling, and restricted movement in her right upper limb and unable to stand after a minor fall. Initially, she received treatment in the orthopedics department for fractured right humerus and both shaft of femur, then transferred to the medicine department for further evaluation. Serum parathyroid and calcium levels were elevated. A 99m TC MIBI parathyroid SPECT-CT scan revealed persistence of the intense focal radiotracer concentration at right lobe thereby confirming a lower right parathyroid adenoma. <b>Conclusions</b>: This case underscores the potential for primary hyperparathyroidism to manifest with atypical symptoms, leading to delayed diagnosis and management.