Global surge in hyperparathyroidism: Trends in incidence, prevalence, and parathyroidectomy rates

The incidence and prevalence of primary hyperparathyroidism (PHPT) are known to be increasing, yet few studies have explored these trends on a global scale. This study aims to examine worldwide trends in PHPT incidence, prevalence, and parathyroidectomy rates, while identifying potential factors contributing to the observed rise in PHPT cases.

A retrospective analysis of the TriNetX Global database was conducted from 1998 to 2023 to assess the incidence and prevalence of PHPT. Patients with renal hyperparathyroidism or other secondary causes of hypercalcemia were excluded. Patients were classified into PHPT subtypes based on serum calcium and parathyroid hormone (PTH) levels. Classic PHPT (cPHPT) was defined as calcium ≥10.5 mg/dL and PTH ≥66 pg/mL, ncPHPT as calcium levels between 8.8 and 10.4 mg/dL with PTH ≥66 pg/mL, and nhPHPT as calcium ≥10.5 mg/dL with PTH between 21 and 65 pg/mL. Demographic variables, including age, sex, and race/ethnicity, as well as parathyroidectomy status were collected. Annual incidence and prevalence rates per 100,000 population were calculated for each PHPT subtype to examine temporal and demographic trends.

From 1998 to 2023, the global incidence of primary hyperparathyroidism (PHPT) increased more than seven-fold, from 3.5 to 26.9 per 100,000, while prevalence rose from 4.2 to 245 per 100,000. The greatest growth occurred in normocalcemic PHPT (ncPHPT), with incidence rising from less than 1 to 16.2 per 100,000, now representing the dominant global phenotype. Females accounted for the majority of cases, and White patients consistently showed the highest rates, though rates among Black and Asian populations grew disproportionately after 2015. Parathyroidectomy utilization remained low, with surgery performed in approximately 38% of cPHPT, 14% of ncPHPT, and 16% of nhPHPT patients despite increasing disease burden.

Global PHPT burden is increasing, driven primarily by ncPHPT, while parathyroidectomy rates remain low, further work is needed to clarify how much of this gap reflects guideline-eligible patients not undergoing surgery versus appropriate non-operative management.