{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T02:18:46Z","timestamp":1789006726165,"version":"build-2803163510"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the frequency and timing of end-organ damage associated with PHPT.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n A new biochemical diagnosis of PHPT was defined as an elevated PTH (&amp;gt;65 pg\/mL) within 1 month after a second elevated calcium level (serum calcium &amp;gt;10.2 mg\/dL or ionized calcium &amp;gt;1.3 mmol\/L or &amp;gt;5.3 mg\/dL).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 43\u202f399 patients with PHPT were identified (mean [SD] age, 67.9 [12.5] years; 33\u202f854 [78%] female and 9545 [22%] male), of whom 22\u202f279 (51.3%) had end-organ damage at diagnosis. Among 21\u202f120 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.3051","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:30:33Z","timestamp":1785339033000},"page":"936","source":"Crossref","is-referenced-by-count":1,"title":["End-Organ Damage Associated With Primary Hyperparathyroidism"],"prefix":"10.1001","volume":"161","author":[{"given":"Lia D.","family":"Delaney","sequence":"first","affiliation":[{"name":"Stanford\u2013Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, California"},{"name":"Department of Surgery, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather S.","family":"Day","sequence":"additional","affiliation":[{"name":"Stanford\u2013Surgery Policy 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