Back to 2026 Abstracts
A Retrospective Analysis of Stone Events and Treatment Following Medical vs Surgical Management of Primary Hyperparathyroidism: A National Database Review
Jack William Pearce, B.S.1, Nicholas Khoo, B.S.1, Patrick Flaherty, B.S.1, Jake Bleau, B.S.1, Sidney Gregorek, B.A.1, Benjamin Rubin, B.S.1, Clara Goebel, B.A.1, Brian H. Irwin, MD2, Jenna Winebaum, MD2, Richard T. Grunert, MD2, Mohammad Mohaghegh, MD2.
1University of Vermont College of Medicine, Burlington, VT, USA, 2University of Vermont Medical Center, Burlington, VT, USA.
Background: Primary Hyperparathyroidism (PHPT) is a metabolic disorder that puts patients at risk for nephrolithiasis. Patients with PHPT are treated through two main methods: parathyroid resection (PTx) or off-label cinacalcet medical management. Currently, there is limited data identifying the frequencies of stone events in patients with different PHPT treatment regimens.
Methods: A retrospective analysis was preformed using the TriNetX Research Network. Patients were identified using ICD-10 diagnosis codes and CPT procedural codes for PHPT and filtered for subsequent intervention with cinacalcet or PTx. Patients on cinacalcet with prior PTx or patients with PTx and prior cinacalcet use were excluded in their respective populations. A 1:1 propensity-score matching algorithm was utilized to balance demographics and comorbidities. Primary outcomes included frequencies of additional nephrolithiasis diagnosis and stone-related surgical interventions (ESWL, URS, PCNL).
Results: Initial analysis isolated 165,490 patients with a diagnosis of PHPT with 18,334 reporting a stone event within five years after PHPT diagnosis. Matched cohorts of 338 were compared on frequencies of additional nephrolithiasis diagnoses and stones requiring surgical intervention within a five-year window. Within the five-year follow-up window, a significant difference in new nephrolithiasis diagnoses was identified between cinacalcet treatment and PTx cohorts. 12.2% of cinacalcet patients and 30.8% of PTx patients were not diagnosed with new nephrolithiasis at the end of the five-year window [HR, 1.971; 95% CI, 1.308-2.969; p=0.0009]. For stones requiring surgical intervention, there was no significant difference in frequency observed within the five-year window [HR, 1.437; 95% CI, 0.716-2.884; p=0.96].
Conclusions: This study is the first to compare the frequency of post-PHPT diagnosis stone events between PTx and off-label cinacalcet treatment. Our analysis identified a significant difference in five-year overall nephrolithiasis, but no significant difference in the frequency of stones requiring surgical management. More prospective studies are needed to validate these findings.
Back to 2026 Abstracts
