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ACTH and gonadotropin deficiencies predict mortality in patients treated for nonfunctioning pituitary adenoma: long‐term follow‐up of 519 patients in two large European centres
Author(s) -
O'Reilly Michael W.,
Reulen Raoul C.,
Gupta Saket,
Thompson Claire A.,
Dineen Rosemary,
Goulden Eirena L.,
Bugg Gabriella,
Pearce Harriet,
Toogood Andy A.,
Gittoes Neil J.,
Mitchell Rosalind,
Thompson Christopher J.,
Ayuk John
Publication year - 2016
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13141
Subject(s) - hypopituitarism , medicine , pituitary adenoma , endocrinology , context (archaeology) , cohort , adrenocorticotropic hormone , proportional hazards model , adenoma , hormone , biology , paleontology
Summary Context and Objective Nonfunctioning pituitary adenomas ( NFPA s) are the most common subtype of pituitary tumour. Hypopituitarism is observed in NFPA s due to tumour‐ or treatment‐related factors and may increase mortality risk. Here, we analysed the associations of hypopituitarism, hormone replacement and mortality in a large NFPA cohort derived from two large European centres. Design, Setting and Participants Case note review of all patients treated for NFPA in University Hospitals Birmingham and Beaumont Hospital Dublin between 1999 and 2014 was performed. Main Outcome Measures Clinical presentation, treatment strategies, pituitary function and vitality status were recorded in each patient. A multivariate Cox regression model was used to examine the association between hypopituitarism, hormone replacement and premature mortality. Results A total of 519 patients were included in the analysis. Median duration of follow‐up was 7·0 years (0·5–43). A total of 81 deaths were recorded (15·6%). On multivariate analysis, adrenocorticotropic hormone ( ACTH ) and gonadotropin (Gn) deficiencies were associated with an increased relative risk of death ( OR 2·26, 95% CI 1·15–4·47, P = 0·01 and OR 2·56, 95% CI 1·10–5·96, P = 0·01, respectively). Increased hydrocortisone ( HC ) ( P ‐trend = 0·02) and lower levothyroxine ( LT 4) doses ( P ‐trend = 0·03) were associated with increased risk of death. Mortality increased with the degree of pituitary failure observed ( P ‐trend = 0·04). Conclusion ACTH and gonadotropin‐deficient patients have higher mortality rates compared to those with intact hormonal axes. Excessive HC and suboptimal LT 4 replacement may also increase risk of death. Complex associations between hormone deficiency and replacement underpin the increased mortality risk in NFPA patients.