The most common cause of primary hyperparathyroidism is a solitary parathyroid adenoma. The different manifestations of the disease are due to excess parathyroid hormone (PTH) secretion. “Giant parathyroid adenomas” weigh more than 2 g and are rarely evident in clinical examination. We present a young man who presented with severe bone deformities and a palpable neck lump. After surgery, a giant parathyroid adenoma was removed that weighed 33 g. Adenomas weighing more then 30 g are rare and presentation as a neck lump and severe bone disease has seldom been described. In patients presenting with a palpable neck lump, severe bone disease and renal calculi giant parathyroid adenomas should be considered as a possible culprit.