Mortality among patients with nonfunctioning pituitary adenomas (NFPA) was higher in women than in man as well as in patients with a young age at diagnosis and those diagnosed with diabetes insipidus, according to a nationwide population-based study in Sweden.
Dr. Daniel S. Olsson of the University of Gothenburg and Sahlgrenska University Hospital in Gothenburg, Sweden, and his associates identified 2,795 unique patients with NFPA from the the Swedish National Patient Registry who had been diagnosed between 1987 and 2011. The mean age at diagnosis was 58 years, and the mean follow-up time was 7 years.
Standardized mortality ratio was increased in women with NFPA (1.29; 95% confidence interval, 1.11-1.48) but not in men (1.00; 95% CI, 0.88-1.12). Women with a diagnosis of hypopituitarism and/or diabetes insipidus had increased mortality ratio, but men did not (J. Clin. Endocrinol. Metab. 2015 May 7 [doi: 10.1210/jc.2015-1475]).
“We found an association between increased mortality and the presence of hypopituitarism in women with NFPA, which has been indicated in previous studies, but not clearly demonstrated. In contrast, men with hypopituitarism had no excess mortality,” the authors wrote.
Other predictors of excess mortality included being diagnosed under 40 years of age, as those patients had an increased SMR of 2.68 (95% CI, 1.23-5.09). Patients with hypopituitarism in combination with NFPA had an SMR of 1.06 (95% CI, 0.94-1.19) and for patients with diabetes insipidus the SMR was 1.71 (95% CI, 1.07-2.58).
Though the exact mechanisms behind the increased mortality ratios are unclear, the investigators noted that “adrenal insufficiency and its treatment in hypopituitary patients contributed to the excess mortality seen in these patients, although other pituitary hormone deficiencies, such as growth hormone deficiency may also play an important role.”
The authors noted that their study is the first to report the frequency of hypopituitarism (54%) in a large cohort of unselected patients with NFPA.
Dr. Olsen has received lecture fees from Pfizer and has been a consultant for Ipsen.