Delayed Diagnosis and Late Presentation of Primary Hyperparathyroidism in Somalia: A Case Report and Literature Review

Abstract

Primary hyperparathyroidism (PHPT) is a rare endocrine disorder characterized by elevated serum calcium levels due to overproduction of parathyroid hormone (PTH). While parathyroid adenomas are the most common cause, they can present diagnostic and management challenges, especially in resource-limited settings. We present the case of a 51-year-old Somali female with a six-year history of generalized weakness, fatigue, and nonspecific abdominal pain. Laboratory investigations revealed elevated PTH levels (231 ng/ml) and hypercalcemia (14 mg/dl), consistent with PHPT. Cervical ultrasound identified a hypoechoic hypervascular solitary lesion suggestive of a parathyroid adenoma. The patient underwent a successful parathyroidectomy, resulting in the normalization of serum calcium levels and symptomatic relief. Histopathological examination confirmed the diagnosis of parathyroid adenoma. This case underscores the importance of early recognition and intervention in PHPT, particularly in underserved regions where healthcare resources may be limited. Efforts to raise awareness, provide training for healthcare workers, and improve access to diagnostic and treatment modalities are crucial in optimizing outcomes for patients with PHPT.