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Dr. Sam Wiseman presents his talk, “Secondary & Tertiary Hyperparathyroidism: A Surgical Perspective,” as part of BC Renal and UBC’s province-wide rounds. 0:06:00 – Introduction of Secondary HPT Dr. Wiseman begins by talking about secondary hyperparathyroidism (SHPT), which is marked by abnormal concentrations of calcium and phosphorous, as a physiological adaptation to progressive kidney disease. As a result, nodules form on parathyroid glands. He discusses the KDIGO guidelines for treating patients with SHPT, noting that when people don’t respond to medical therapy, surgery to remove part of all of the parathyroid glands is an option. 0:14:00 – Benefits of Parathyroidectomy He notes numerous benefits of surgery to remove the parathyroid, including a reduction in all cause mortality and cardiovascular mortality compared to patients treated with medical treatment. 0:16:00 – Parathyroidectomy for Tertiary HPT Dr. Wisman notes there is a lack of consensus regarding the exact definition for tertiary hyperparathyroidism (THPT), and provides on overview of symptoms. He highlights data from some small studies showing that surgery is also superior compared to medical treatment for people with tertiary HPT. 0:20:00 – Pre-operative Process Dr. Wiseman talks about how a Sestamibi scan and ultrasound can help with pre-operative planning. He discusses preoperative issues and management strategies (e.g. cacitrol, vitamin D repletion, preoperative electrolytes in dialysis patients, etc.) 0:25:00 – Operative Approach for Secondary HPT He then delves into the operation itself, describing the subtotal parathyroidectomy approach (removal of 3.5 glands) versus the total parathyroidectomy approach (removal of all 4 glands) with or without autotransplantation, for SHPT. He highlights data comparing the different approaches, finding them comparable, although total parathyroidectomy autotransplantation involved a few more cons (e.g., longer hospital stays). 0:37:00 – Operative Approach for Tertiary HPT Dr. Wiseman notes that no single operation is uniformly recommended for tertiary HPT cases. He then discusses ways for intraoperative PTH monitoring and highlights AAES recommendations on decision-making. Parathyroid cryopreservation allows for delayed autotransplantation of parathyroid glands and can be stored up to a year in BC, he notes. 0:44:00 – Surgical Outcomes Lastly, Dr. Wiseman provides on overview of surgical outcomes for SHPT and THPT. (e.g., hungry bone syndrome), and chances of persistence or recurrence. He notes the surgeon volume influences parathyroid parathyroidectomy outcomes. 0:47:00 – Conclusions and Q&A Dr. Wiseman summarizes his key points before taking questions from the audience. Click here to join our mailing list to receive the latest news and information from BC Renal: https://app.cyberimpact.com/clients/2...