ArticleJAMA surgery2026
End-Organ Damage Associated With Primary Hyperparathyroidism.
Article in JAMA surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Importance: Primary hyperparathyroidism (PHPT) is common and contributes to skeletal and kidney end-organ damage. Although parathyroidectomy can mitigate these complications, many patients are managed with observation, and real-world data on the population-based frequency and timing of end-organ damage under usual care are limited. Objective: To evaluate the frequency and timing of end-organ damage associated with PHPT. Design, Setting, and Participants: This cohort study included a population-based cohort identified from national electronic health record (EHR) and claims data (2010-2023) with follow-up through 2023. Participants were adults with a new biochemical diagnosis of PHPT. Data analysis was performed from August 2025 to April 2026. Exposure: A new biochemical diagnosis of PHPT was defined as an elevated PTH (>65 pg/mL) within 1 month after a second elevated calcium level (serum calcium >10.2 mg/dL or ionized calcium >1.3 mmol/L or >5.3 mg/dL). Main Outcomes and Measures: PHPT-associated end-organ damage (osteoporosis, atraumatic fractures, kidney stones, stage 3 or worse chronic kidney disease) at or after PHPT diagnosis using EHR or claim codes and laboratory data, in addition to the frequency and timing of parathyroidectomy. Results: A total of 43 399 patients with PHPT were identified (mean [SD] age, 67.9 [12.5] years; 33 854 [78%] female and 9545 [22%] male), of whom 22 279 (51.3%) had end-organ damage at diagnosis. Among 21 120 patients without end-organ damage at diagnosis, 6762 (32.0%) progressed to end-organ damage after a median (IQR) 516 (166-1125) days. Only 4442 patients (19.9%) with end-organ damage at diagnosis were treated with parathyroidectomy. Among those who progressed to end-organ damage, 1348 (19.9%) underwent subsequent parathyroidectomy, which occurred a median (IQR) 154 (41-439) days later. Conclusions and Relevance: In this national cohort of adults with a biochemical diagnosis of PHPT, 67% had PHPT-associated end-organ damage at diagnosis or on follow-up. Despite this, parathyroidectomy was uncommon. These findings may inform strategies to optimize utilization of parathyroidectomy and mitigate PHPT-associated morbidity.
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