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Parathyroidectomy Secondary HPT — RACP Adult Medicine MCQ

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HardNephrologyParathyroidectomy Secondary HPTRACP Adult Medicine

A 55-year-old man with CKD5 on dialysis. Secondary hyperparathyroidism refractory to cinacalcet, phosphate binders, vitamin D analogues. PTH >1500 pg/mL with progressive bone disease. Surgical intervention?

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Correct answer: E — Total parathyroidectomy with forearm autotransplantation

Refractory secondary HPT: total parathyroidectomy + forearm autotransplant. Post-op hungry bone syndrome requires careful Ca²⁺/calcitriol management.

Reference: KHA-CARI – 2013; KDIGO – 2017