End-Organ Damage Associated With Primary Hyperparathyroidism

Area of Science:

• Endocrinology and Metabolism
• Nephrology
• Orthopedics

Background:

• Primary hyperparathyroidism (PHPT) is a prevalent endocrine disorder.
• PHPT can lead to significant skeletal and kidney complications.
• Real-world data on end-organ damage progression in PHPT under usual care are limited.

Purpose of the Study:

• To determine the frequency and timing of end-organ damage in patients with PHPT.
• To assess the utilization of parathyroidectomy in managing PHPT-associated complications.

Main Methods:

• A population-based cohort study using national electronic health record and claims data (2010-2023).
• Included adults with a new biochemical diagnosis of PHPT.
• Evaluated end-organ damage (osteoporosis, fractures, kidney stones, CKD) and parathyroidectomy rates.

Main Results:

• 67% of 43,399 PHPT patients had end-organ damage at diagnosis or during follow-up.
• Among those without initial damage, 32% progressed to end-organ damage.
• Parathyroidectomy was performed in only 19.9% of patients with end-organ damage.

Conclusions:

• A high proportion of PHPT patients develop end-organ damage, often at diagnosis.
• Parathyroidectomy rates remain low despite significant morbidity.
• Findings suggest opportunities to improve parathyroidectomy utilization and mitigate PHPT complications.