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Invited Commentary
October 9, 2019

Quantifying the Possible Consequences of Parathyroidectomy on Hypertension in Patients With Primary Hyperparathyroidism: Bones, Kidneys, Brain—and Heart?

Author Affiliations
  • 1Department of Surgery, University of California, San Francisco, San Francisco
JAMA Surg. Published online October 9, 2019. doi:10.1001/jamasurg.2019.3961

When counseling patients regarding the potential benefits of parathyroidectomy for primary hyperparathyroidism (PHPT), surgeons discuss the possible short-term and long-term consequences of operation. The short-term benefits may include alleviation of fatigue, bone aches, depressed mood, and frequent urination. While it is extremely rewarding to improve these symptoms, it is the long-term benefits that may be truly life-altering and potentially lifesaving. The organs most likely to be negatively affected by PHPT are the bones, kidneys, brain, and heart. Medical students everywhere still learn about the effects of this disease on the first 3: who will ever forget the stones/bones/groans mnemonic? But it is the heart that typically gets left out of the discussion, even though compelling evidence has mounted over the decades demonstrating the serious cardiovascular consequences of PHPT, including ventricular hypertrophy, vascular calcifications, and increased risk for significant cardiac events, such as stroke, heart failure, and myocardial infarction.1-3 The death of comedian Garry Shandling in 2016 was attributed to cardiac disease from untreated PHPT, as highlighted in an article entitled “Garry Shandling and the Disease You Didn’t Know About.”4

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