Primary Hyperparathyroidism Presenting with Multiple Pathological Fractures and Normocalcaemia

The diagnosis of primary hyperparathyroidism (PHPT) is a rarity in developing countries. We report a 30-year old Nigerian farmer seen at the Usmanu Danfodiyo University Teaching Hospital, Sokoto with multiple pathological fractures. The diagnosis of PHPT was made based on these bone changes and the elevated parathyroid hormone level. The patient however had normocalcaemia. Computerised tomography localised a left inferior parathyroid adenoma. He had uneventful parathyroidectomy but developed hungry bone syndrome that was successfully treated with active vitamin D and oral calcium. The differences in presentation between patients from developed countries as well as the apparent rarity of PHPT in tropical countries are stressed