An unusual presentation of primary hyperparathyroidism: severe hypercalcemia and multiple brown tumors

Abstract

Primary hyperparathyroidism is common, particularly in postmenopausal women. Since the introduction of routine automated serum calcium assays and the development of assays for intact 1-84 parathyroid hormone, the diagnosis is usually made fortuitously in asymptomatic patients or during evaluation for osteoporosis. As a result, many physicians have no experience with the clinical manifestations. Here, we describe the case of a 70-year-old man with bone pain, multiple brown tumors, and severe hypercalcemia (4 mmol/L). The diagnostic pitfalls raised by these symptoms are illustrated.