Giant parathyroid adenoma mimicking as gallstone disease and musculoskeletal disorders: a case report from a resource-limited setting.

Introduction and importance: Giant parathyroid adenomas (GPAs) are rare causes of primary hyperparathyroidism and may mimic various other disorders, leading to diagnostic delays. Early identification is key, especially in resource-limited settings. Presentation of case: We present the case of a 56-year-old woman with vague symptoms like body pain, constipation, and nocturia. She was initially misdiagnosed with gallstone disease and musculoskeletal pain. Further evaluation revealed a serum calcium of 16.04 mg/dl and a parathyroid hormone (PTH) level of 2118 pg/ml. Imaging confirmed a left parathyroid adenoma. Surgical excision of an 8.95 g mass led to resolution of symptoms and normalization of calcium and PTH. Clinical discussion: GPAs, though benign, often present with severe symptoms and biochemical abnormalities mimicking malignancy. Diagnostic challenges include overlapping presentations and limited imaging resources. Low urinary calcium in this patient was attributed to chronic renal adaptation. Conclusion: Giant parathyroid adenomas should be considered in patients with hypercalcemia and vague musculoskeletal symptoms. Timely diagnosis and surgery are curative, even in low-resource settings.