Primary hyperparathyroidism: a case with severe skeletal manifestations.

Over the years, patients with primary hyperparathyroidism are often asymptomatic and diagnosis is suspected on the incidental finding of hypercalcaemia. We report a patient, a middle-aged man from northern Sumatra, with a florid but uncommon presentation of severe bone pains and bilateral femoral neck fractures. He was found to have a solitary parathyroid adenoma which was successfully removed surgically. Postoperatively, the patient had severe symptomatic hypocalcaemia that required aggressive replacement therapy with calcium, magnesium and active vitamin D. He was well clinically and had significant improvement of biochemical indices on follow-up at 3 months. This report is followed by a review on the management of this condition.