Excess Mortality Associated With Hypopituitarism in Adults: A Meta-Analysis of Observational Studies

Pappachan, Joseph M; Raskauskiene, Diana; Kutty, V. Raman; Clayton, Richard N.

doi:10.1210/jc.2014-3787

Cited by 106 publications

(67 citation statements)

References 32 publications

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“…In accordance with previous epidemiological studies on mortality in patients with hypopituitarism (3,6), young patients with NFPAs were shown to be especially exposed with 3 to 6 times increased incidences of type 2 diabetes mellitus, cerebral infarction and sepsis. Even though the number of individual cases with these comorbidities was relatively small, and the 95% CIs were consequently wide, preventive measures for patients diagnosed with NFPAs at young age should not be underestimated.…”

Section: Discussionsupporting

confidence: 89%

“…Hypopituitary patients have excess vascular mortality and increased occurrence of the metabolic syndrome, diabetes mellitus, cardiac diseases and non-fatal stroke (1,2,3,16,18,19). The reason for this is probably multifactorial, with non-physiologic glucocorticoid replacement, untreated growth hormone deficiency and undertreatment with sex steroids being suggested explanations (2,20).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with hypopituitarism have an increased mortality ratio, mainly due to respiratory, cardiovascular and cerebrovascular causes (1,2,3,4,5). The reason for the excessive mortality is currently not fully understood although some factors associated with increased risk have been identified.…”

Section: Introductionmentioning

confidence: 99%

“…Women have also an increased risk of premature death compared with men as well as patients with pituitary adenoma operated by transcranial surgery compared with those treated by transphenoidal surgery (3). Pituitary radiation therapy, untreated growth hormone deficiency and high glucocorticoid replacement doses may also implicate increased risk (2,3,7,8,9).…”

Section: Introductionmentioning

confidence: 99%

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Higher incidence of morbidity in women than men with non-functioning pituitary adenoma: a Swedish nationwide study

Olsson

Bryngelsson

Ragnarsson

2016

European Journal of Endocrinology

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Objective: Increased mortality rates are found in women and young adults with non-functioning pituitary adenomas (NFPAs). This nationwide study aimed to investigate the burden of comorbidities in patients with NFPA and to examine whether gender influences the outcome. Design: NFPA patients were identified and followed-up from National Registries in Sweden. It was a nationwide, population-based study. Method: Standardised incidence ratios (SIRs) for comorbidities with 95% confidence intervals (CI). Comorbidities were analysed in all patients, both patients with and without hypopituitarism. Results: Included in the analysis were 2795 patients (1502 men, 1293 women), diagnosed with NFPA between 1987 and 2011. Hypopituitarism was reported in 1500 patients (54%). Mean patient-years at risk per patient was 7 (range 0-25). Both men (SIR 2.2, 95% CI: 1.8-2.5; P < 0.001) and women (2.9, 2.4-3.6; P < 0.001) had a higher incidence of type 2 diabetes mellitus (T2DM) than the general population, with women having a higher incidence compared with men (P = 0.02). The incidence of myocardial infarction was increased in women (1.7, 1.3-2.1; P < 0.001), but not in men. Both men (1.3, 1.1-1.6; P = 0.006) and women (2.3; 1.9-2.8; P < 0.001) had an increased incidence of cerebral infarction, with women having a higher incidence than men (P < 0.001). The incidence of sepsis was increased for both genders. The incidence of fractures was increased in women (1.8, 1.5-1.8; P < 0.001), but not for men.Conclusions: This nationwide study shows excessive morbidity due to T2DM, cerebral infarction and sepsis in all NFPA patients. Women had higher incidence of T2DM, myocardial infarction, cerebral infarction and fracture in comparison to both the general population and to men.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Higher incidence of morbidity in women than men with non-functioning pituitary adenoma: a Swedish nationwide study

Olsson

Bryngelsson

Ragnarsson

2016

European Journal of Endocrinology

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“…Long-term studies on the effect of GH replacement therapy have since shown an improvement in many of these features, such as improved lean body mass, decreased body fat, beneficial effects on plasma lipids, positive effects on intima media thickness, improvement in bone mineral density, and better quality of life [15]. Lately, partly due to a recently published study, a growing body of evidence is showing that GH replacement therapy is associated with reduced excess mortality or normalized mortality compared to the general population [5,16]. We have shown that GH replacement therapy is associated with normalized mortality among over 400 non-functioning pituitary adenoma patients receiving or not receiving GH replacement, who were followed for 10 years [5].…”

mentioning

confidence: 99%

Hypopituitarism—needs modern individualized treatment

Olsson

Bengtsson

2016

Endocrine

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Diagnosis and Management of Pituitary Adenomas

Tritos

Miller

2023

JAMA

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ImportancePituitary adenomas are neoplasms of the pituitary adenohypophyseal cell lineage and include functioning tumors, characterized by the secretion of pituitary hormones, and nonfunctioning tumors. Clinically evident pituitary adenomas occur in approximately 1 in 1100 persons.ObservationsPituitary adenomas are classified as either macroadenomas (≥10 mm) (48% of tumors) or microadenomas (&lt;10 mm). Macroadenomas may cause mass effect, such as visual field defects, headache, and/or hypopituitarism, which occur in about 18% to 78%, 17% to 75%, and 34% to 89% of patients, respectively. Thirty percent of pituitary adenomas are nonfunctioning adenomas, which do not produce hormones. Functioning tumors are those that produce an excess of normally produced hormones and include prolactinomas, somatotropinomas, corticotropinomas, and thyrotropinomas, which produce prolactin, growth hormone, corticotropin, and thyrotropin, respectively. Approximately 53% of pituitary adenomas are prolactinomas, which can cause hypogonadism, infertility, and/or galactorrhea. Twelve percent are somatotropinomas, which cause acromegaly in adults and gigantism in children, and 4% are corticotropinomas, which secrete corticotropin autonomously, resulting in hypercortisolemia and Cushing disease. All patients with pituitary tumors require endocrine evaluation for hormone hypersecretion. Patients with macroadenomas additionally require evaluation for hypopituitarism, and patients with tumors compressing the optic chiasm should be referred to an ophthalmologist for formal visual field testing. For those requiring treatment, first-line therapy is usually transsphenoidal pituitary surgery, except for prolactinomas, for which medical therapy, either bromocriptine or cabergoline, is usually first line.Conclusions and RelevanceClinically manifest pituitary adenomas affect approximately 1 in 1100 people and can be complicated by syndromes of hormone excess as well as visual field defects and hypopituitarism from mass effect in larger tumors. First-line therapy for prolactinomas consists of bromocriptine or cabergoline, and transsphenoidal pituitary surgery is first-line therapy for other pituitary adenomas requiring treatment.

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Excess Mortality Associated With Hypopituitarism in Adults: A Meta-Analysis of Observational Studies

Abstract: Hypopituitarism may increase premature mortality in adults. Mortality benefit from GH replacement in hypopituitarism is less pronounced in women than men.

Cited by 106 publications

References 32 publications

Higher incidence of morbidity in women than men with non-functioning pituitary adenoma: a Swedish nationwide study

Higher incidence of morbidity in women than men with non-functioning pituitary adenoma: a Swedish nationwide study

Hypopituitarism—needs modern individualized treatment

Diagnosis and Management of Pituitary Adenomas

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