PTH and endocrine system disorder: <h4>Background</h4>Primary hyperparathyroidism (PHPT) is a relatively common endocrine disorder, although advanced skeletal manifestations mimicking metastatic malignancy are uncommon, characterized by autonomous oversecretion of parathyroid hormone.<h4>Case presentation</h4>We report the case of a 67-year-old female who presented with cough and chest pain and was later found to have extensive osteolytic lesions initially suspected as malignant bone metastases.