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Secondary Hyperparathyroidism in a Patient with Eight Parathyroid Glands

Department of Surgery, University of California Los Angeles School of Medicine, Los Angeles, California 90095-6904

Address all correspondence and requests for reprints to: H. Earl Gordon, M.D., Division of General Surgery, UCLA School of Medicine, Box 956904, Los Angeles, California 90095-6904.

The etiology of secondary hyperparathyroidism is multifactorial, and as many as 10% of patients will ultimately require surgical intervention. This condition is most commonly caused by four-gland hyperplasia. We describe a patient who presented with secondary hyperparathyroidism and symptoms of memory loss, pruritus, constipation, and bone and joint pain. These complaints could not be controlled with conventional therapy. Over a three-year period, the patient underwent three neck explorations, 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 hyperparthyroidism can be caused by seeding at the time of operation, the glands 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 discussion of the possible causes of this unusual presentation is included.