800 J. Endocrinol. Invest. 25: 800-803, 2002 ABSTRACT. Here we describe the uncommon case of a Caucasian male with secondary hy- perparathyroidism due to 8 parathyroid glands discovered in the course of a surgical explo- ration. The patient (age 49 yr) with a 21-yr his- tory of chronic renal failure came to our ob- servation in June 1999 complaining of de- pression, muscle weakness, bone and joint pain, movement hindrance. The biochemical evaluation evidenced low-normal serum calci- um, high phosphorus and PTH levels. The symptoms and the biochemical findings were suggestive for secondary hyperparathyroidism. The neck US revealed an increase of thyroid gland volume with diffuse hyperechogenity; two nodules of 20 and 25 mm as maximum di- ameter were found in the thyroid parenchyma, while 4 hypoechogenous nodules (maximum diameter ranging from 13.0 to 30.0 mm) with clean borders and anechogenous areas inside were evidenced in the rear side of the thyroid lobes. The parathyroid scan with 99 m Tc and 201 Tl demonstrated increased uptake bilat- erally in the inferior side of the neck. The pa- tient underwent a total parathyroidectomy with near total thyroidectomy in November 1999. Histological examination of surgical specimen evidenced 6 hyperplastic parathy- roid glands in back side of the 2 lobes (3 on the right and 3 on the left), and the examina- tion of the thyroid gland showed 2 hyperplas- tic parathyroids (5 mm and 15 mm maximum diameter) into the 2 nodules previously evi- denced by US. The physiopathological and clinical and therapeutic implications of this ob- servation are discussed. (J. Endocrinol. Invest. 25: 800-803, 2002) © 2002, Editrice Kurtis INTRODUCTION Secondary hyperparathyroidism is a frequent find- ing in patients with chronic renal failure (1, 2). Hyperphosphoremia, decreased calcitriol and ion- ized calcium levels constitute the chronic stimulus for parathyroids, leading to secondary hyperpara- thyroidism (3). Pharmacological treatment of this disease is very hard, making surgery a useful ther- apeutic option (4). The constant stimulus induced by chronic renal dis- ease and the embriological origin may create the condition favoring the development of ectopic and/or supernumerary hyperplastic glands. In fact, the lower and the superior glands show different embryological origin: the former develop from the dorsal endoderm of the third pharyngeal pouch which is also associated with thymus, whereas the latter develop from the dorsal endoderm of the fourth pharyngeal pouch and migrate caudally with the lateral lobes of the thyroid. Indeed, in renal fail- ure the usual anatomical finding of 4 parathyroid glands is very often modified, with the appearance of hyperplastic or ectopic or supernumerary parathyroid glands (5). Here, we describe the uncommon case of a Cau- casian male with secondary hyperparathyroidism due to 8 parathyroid glands discovered during a Key-words: Secondary hyperparathyroidism, supernumerary parathyroids, PTH, renal failure. Correspondence: Dr. Giovanni Amato, Via Orsi 33, 80128 Napoli Italia. E-mail: giovanni.amato@unina2.it Accepted April 29, 2002. CASE REPORT Eight parathyroid glands incidentally discovered during a surgical intervention for secondary hyperparathyroidism: An unusual clinical finding G. Amato*, E. Lalli*, G. Mazziotti*, G. De Felice*, M. Rotondi*, G. Vitolo*, A. Saggese**, A. Livrea***, A. Bellastella* and C. Carella* *Institute of Endocrinology, **Institute of Nefrology and ***Institute of Surgery, Second University of Naples, Naples, Italy