The effect of hypopituitarism on life expectancy.

Abstract

One hundred and seventy-two patients with partial or complete hypopituitarism diagnosed between 1967 and 1994 were studied retrospectively. Those with acromegaly or Cushing's disease were excluded. One hundred and two patients were male (median age at, diagnosis, 53 yr; range, 12-78 yr) and 70 female (median age at diagnosis, 51 yr; range, 1-74 yr). In 131 patients the cause of hypopituitarism was a pituitary tumor or the effects of its treatment, as the majority underwent surgery and/or radiotherapy. In 22, the cause was an extrapituitary tumor, 14 were termed idiopathic, 2 developed hypopituitarism as a result of basal sarcoid, 2 were due to trauma, and 1 was the result of Sheehan's syndrome. The patients were treated with standard replacement therapy. Mortality due to all causes was higher than expected in an age- and sex-matched control population (ratio of observed/expected deaths, 1.73; 95% confidence interval, 1.28-2.28; P < 0.01). Females tended to have a worse prognosis (ratio of observed/expected deaths, 2.29; 95% confidence interval, 1.37-3.58; P < 0.01) than their male counterparts (ratio of observed/expected deaths, 1.50; 95% confidence interval, 1.02-2.13; P < 0.01). There was a small but nonsignificant increase in the number of deaths due to vascular disease (ratio of observed/expected deaths, 1.35; 95% confidence interval, 0.84-2.07; P = 0.11). The only significant independent predictive factors for survival were age at diagnosis and hypogonadism. The majority of the male hypogonadal cohort received replacement therapy (79%), but fewer of the females did so (27%). Hypogonadal patients had a better prognosis than their eugonadal counterparts (log rank, 6.85; P < 0.01). Our data confirmed that mortality in patients with hypopituitarism is significantly increased. However, the contribution of vascular disease to this poor prognosis was not as great as previously reported, and overall, our results favor a multifactorial explanation of the poor long term outcome.

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

“…However, after correction for pituitary dysfunction, this association was no longer significant, suggesting that the observed increase in premature mortality is mediated by RT‐induced hypopituitarism rather than an independent effect of RT itself. These data are consistent with findings from Tomlinson and other older studies,16, 36 as well as the more recent van Varsseveld and Oxford studies 17, 35. There was a trend towards an increased risk of cerebrovascular death compared to nonirradiated patients, but this did not reach statistical significance.…”

Carotid atheromatic plaque is commonly associated with hypopituitary men

“…These results were similar to those in normal aging males [21,22], and patients with diabetes [23,24]. Unlike other studies [2,4,25], our studied patients with hypopituitarism had lower HOMA-IR than the healthy control group (HOMA-IR, 2.22 ± 0.22 vs.…”

Growth Hormone (GH) Effects on Central Fat Accumulation in Adult Japanese GH Deficient Patients: 6-month Fixed-dose Effects Persist during Second 6-month Individualized-dose Phase

“…Epidemiological studies have shown that this abdominal obesity is a risk factor for development of metabolic abnormalities leading to cardiovascular complications [4,5]. In studies in Japanese adult patients with GHD it has been shown that there is an increased risk of cardio-and cerebro-vascular morbidity and mortality compared to the normal population [6][7][8], similar to that previously shown in Caucasian patients [5,[9][10][11].…”