Abstract
PurposePatients with non-functioning pituitary adenomas (NFPA), especially women, have increased mortality. The aim of this study was to investigate whether mortality in NFPA patients has changed during the last two decades.MethodsThis was a nationwide population-based study including 2795 patients (1502 men, 1293 women) diagnosed with NFPA between 1997 and 2011. Patients were identified and followed in Swedish National Health Registries. Standardized mortality ratios (SMRs) with 95 % confidence intervals were calculated for three time periods at first NFPA diagnosis using the general population as reference.ResultsMean (±SD) age at NFPA diagnosis was 58.9 ± 16.8 years. Mean (range) follow-up time was 8.3 (0–18) years, resulting in 20,517 patient-years at risk. Surgical treatment and radiotherapy were used in 53 and 5 %, respectively. The prevalence of hypopituitarism was 64 % during the first time period of diagnosis and then declined gradually during the study period (P value for trend <0.0001). The use of pituitary surgery and radiotherapy remained stable. In women, mortality was increased for patients diagnosed between 1997 and 2006 but not for those diagnosed between 2007 and 2011. The SMR in men remained stable throughout the study and did not differ from the general population. During the last time period, 2007–2011, the SMR between men and women did not differ.ConclusionsWhile mortality in men with NFPA remains normal and stable during the last two decades, mortality in women has declined. Decreasing prevalence of pituitary insufficiency may be a plausible explanation for this positive development.
Highlights
Hypopituitary patients have increased mortality [1,2,3,4]
We have recently demonstrated that patients, women, with non-functioning pituitary adenoma (NFPA), have an increased mortality compared to the background population [5]
In this study we present the first analysis of time trends of mortality in patients with non-functioning pituitary adenomas (NFPA)
Summary
Several factors associated with increased risk have been suggested such as etiology, inadequate hormone replacement treatment, pituitary radiotherapy, transcranial surgery, and diagnosis of hypopituitarism at young age [2, 3, 5,6,7]. Women with pituitary insufficiency have frequently been found to have an increased mortality compared to men [1, 3, 8]. We have recently demonstrated that patients, women, with non-functioning pituitary adenoma (NFPA), have an increased mortality compared to the background population [5]. In the course of the past two decades substantial progress has been achieved in terms of diagnosis, treatment, and surveillance of patients with pituitary insufficiency We have shown that women with NFPA have a higher incidence of type 2 diabetes mellitus, myocardial infarction, cerebral infarction, and fractures in comparison to both the general population and to men [9].
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