SECONDARY HYPERPARATHYROIDISM IN A PATIENT WITH 8 PARATHYROID-GLANDS

The etiology of secondary hyperparathyroidism is multifactorial, and a s many as 10% of patients will ultimately require surgical interventio n. This condition is most commonly caused by four-gland hyperplasia. W e describe a patient who presented with secondary hyperparathyroidism and symptoms of memory loss, pruritus, constipation, and bone and join t pain. These complaints could not be controlled with conventional the rapy. Over a three-year period, the patient underwent three neck explo rations, with complete and persistent relief of his symptoms following the last parathyroidectomy. A total of eight parathyroid glands were removed during these three procedures. Although recurrence of hyperpar thyroidism can be caused by seeding at the time of operation, the glan ds removed during the second and third procedures were not the typical miliary seeding seen with this complication. These glands were solid and hypertrophied and were found in areas not previously explored. A d iscussion of the possible causes of this unusual presentation is inclu ded.